Department of Surgery, VU University Medical Center, Amsterdam, the Netherlands.
Aliment Pharmacol Ther. 2013 Sep;38(6):573-83. doi: 10.1111/apt.12421. Epub 2013 Jul 23.
Delayed gastric emptying limits the administration of enteral nutrition, leading to malnutrition, which is associated with higher mortality and morbidity. Currently available prokinetics have limitations in terms of sustained efficacy and side effects.
To summarise the mechanisms of action and to discuss the possible utility of gastrointestinal hormones to prevent or treat delayed gastric emptying in critically ill patients.
We searched PubMed for articles discussing 'delayed gastric emptying', 'enteral nutrition', 'treatment', 'gastrointestinal hormones', 'prokinetic', 'agonist', 'antagonist' and 'critically ill patients'.
Motilin and ghrelin receptor agonists initiate the migrating motor complex in the stomach, which accelerates gastric emptying. Cholecystokinin, glucagon-like peptide-1 and peptide YY have an inhibiting effect on gastric emptying; therefore, antagonising these gastrointestinal hormones may have therapeutic potential. Other gastrointestinal hormones appear less promising.
Manipulation of endogenous secretion, physiological replacement and administration of gastrointestinal hormones in pharmacological doses is likely to have therapeutic potential in the treatment of delayed gastric emptying. Future challenges in this field will include the search for candidates with improved selectivity and favourable kinetic properties.
胃排空延迟限制了肠内营养的给予，导致营养不良，这与更高的死亡率和发病率有关。目前可用的促动力药物在持续疗效和副作用方面存在局限性。
总结胃肠激素作用机制，并探讨其在预防或治疗危重症患者胃排空延迟中的可能应用。
我们在 PubMed 上搜索了讨论“胃排空延迟”、“肠内营养”、“治疗”、“胃肠激素”、“促动力药”、“激动剂”、“拮抗剂”和“危重症患者”的文章。
胃动素和生长激素释放肽受体激动剂启动胃的移行性运动复合波，加速胃排空。胆囊收缩素、胰高血糖素样肽-1 和肽 YY 对胃排空有抑制作用；因此，拮抗这些胃肠激素可能具有治疗潜力。其他胃肠激素的作用似乎不太有希望。
内源性分泌的操纵、生理替代和胃肠激素的药物剂量给药可能在治疗胃排空延迟方面具有治疗潜力。该领域未来的挑战将包括寻找选择性和动力学特性改善的候选药物。
