McCallum R W, Chen J D, Lin Z, Schirmer B D, Williams R D, Ross R A
Department of Medicine, University of Kansas Medical Center, Kansas City 66160-7350, USA.
Gastroenterology. 1998 Mar;114(3):456-61. doi: 10.1016/s0016-5085(98)70528-1.
BACKGROUND & AIMS: No effective treatment is available for patients with gastroparesis refractory to standard medical therapy. The aim of this study was to investigate the effects of gastric pacing on gastric electrical activity, gastric emptying, and symptoms in patients with gastroparesis.
Nine patients with gastroparesis participated in this study. Four pairs of cardiac pacing wires were implanted on the serosa of the stomach. The protocol consisted of two portions: a temporary inpatient study period and an outpatient study for a period of 1 month or more.
Gastric pacing entrained the gastric slow wave in all subjects and converted tachygastria in 2 patients into regular 3-cpm slow waves. Gastric emptying was significantly improved after the outpatient treatment with gastric pacing. The gastric retention at 2 hours was reduced from 77.0% +/- 3.3% to 56.6% +/- 8.6% (P < 0.05). Symptoms of gastroparesis were substantially reduced at the end of the outpatient treatment (1.51 +/- 0.46 vs. 2.84 +/- 0.61; P < 0.04). Eight of 9 patients no longer relied on jejunostomy tube feeding, and no adverse events were noted related to the pacing unit.
Gastric pacing seems to be able to improve symptoms of gastroparesis and to accelerate gastric emptying in patients with gastroparesis. More controlled studies are necessary to further investigate the role of gastric pacing in clinical practice.
对于标准药物治疗无效的胃轻瘫患者，尚无有效的治疗方法。本研究旨在探讨胃起搏对胃轻瘫患者胃电活动、胃排空及症状的影响。
9例胃轻瘫患者参与本研究。在胃浆膜层植入4对心脏起搏电极。研究方案包括两部分：短期住院研究期和为期1个月或更长时间的门诊研究。
胃起搏使所有受试者的胃慢波同步化，并将2例患者的快速胃动过速转变为规则的每分钟3次的慢波。门诊胃起搏治疗后胃排空显著改善。2小时时的胃潴留率从77.0%±3.3%降至56.6%±8.6%（P<0.05）。门诊治疗结束时，胃轻瘫症状明显减轻（1.51±0.46对2.84±0.61；P<0.04）。9例患者中有8例不再依赖空肠造口管喂养，未观察到与起搏装置相关的不良事件。
胃起搏似乎能够改善胃轻瘫患者的症状并加速胃排空。需要更多对照研究来进一步探讨胃起搏在临床实践中的作用。
