摘要
目的探究体外冲击波刺激足三里及肩髃对糖尿病性胃轻瘫(GDP)患者胃肠动力及自主神经功能的双重调节作用。方法选取2023年6月至2025年2月秦皇岛市第一医院收治的180例GDP患者为研究对象,按随机数字表法分为三组,每组60例。A组采用常规糖尿病管理,B组常规糖尿病管理并体外冲击波刺激足三里,C组常规糖尿病管理并体外冲击波刺激足三里及肩髃,疗程8周。收集患者一般资料,比较治疗8周后临床疗效,治疗前后胃轻瘫症状严重指数量表(GCSI)评分、胃肠动力指标(胃排空时间、胃排空率、胃窦收缩频率)、胃肠激素水平(胃泌素、胃动素、生长抑素)、胃电图指标[胃电主功率比(PDP)、胃电主频率比(PDF)]、心率变异性指标[RR间期平均值标准差(SDANN)、相邻RR间期差值的均方根(RMSSD)、全部窦性心搏RR间期的标准差(SDNN)、低频范围内功率与高频范围内功率的比值(LF/HF)]及不良反应情况。结果三组一般资料差异无统计学意义(P>0.05),基线资料均衡可比。C组总有效率(93.33%)显著高于B组(80.00%)和A组(66.67%),差异有统计学意义(P=0.023)。治疗前,三组在GCSI评分、胃肠动力指标、胃肠激素水平、胃电图指标、心率变异性各指标方面均无统计学差异(P>0.05)。治疗后,三组GCSI评分均显著降低(P<0.001),C组改善幅度最大;三组胃排空时间缩短、胃排空率提升、胃窦收缩频率增加,C组上述改善幅度均优于A、B组(P<0.001);C组胃泌素和胃动素水平显著高于A、B组,生长抑素水平显著低于A、B组(P<0.001);三组PDP和PDF值均显著升高,C组均显著高于A、B组(P<0.05);C组SDANN、RMSSD及SDNN均显著高于A、B组,LF/HF显著低于A、B组(P<0.001)。三组总不良反应发生率差异无统计学意义(P>0.05)。结论体外冲击波刺激足三里及肩髃可显著提高GDP临床疗效,有效改善患者胃肠动力及自主神经功能。
Objective To explore the dual regulatory effects of extracorporeal shock wave stimulation of Zusanli and Jianyu acupoints on gastrointestinal motility and autonomic nerve function in patients with diabetic gastroparesis(GDP).Methods A total of 180 patients with GDP admitted to First Hospital of Qinhuangdao from June 2023 to February 2025 were selected as the research subjects and randomly divided into three groups by random number table method,with 60 cases in each group.Group A received conventional diabetes management.Group B was treated with extracorporeal shock wave stimulation of the Zusanli acupoint.Group C was treated with extracorporeal shock wave stimulation of the Zusanli acupoint combined with the Jianyu acupoint.The treatment course was 8 weeks.The general data of three groups were collected and the clinical efficacy of the three groups after 8 weeks of treatment were compared.The scores of the Gastroparesis Symptom Severity Index(GCSI)before and after treatment,gastrointestinal motility indicators(gastric emptying time,gastric emptying rate,antral contraction frequency),gastrointestinal hormone levels(gastrin,motility,somatostatin),electrogastrogram indicators[gastric main power ratio(PDP),gastric main frequency ratio(PDF)],and heart rate variability performance indicators[standard deviation of RR interval mean(SDANN),root mean square of difference between adjacent RR intervals(RMSSD),standard deviation of RR intervals of all sinus beats(SDNN),ratio of power in the low-frequency range to power in the high-frequency range(LF/HF)]and adverse reaction conditions were compared.Results There were no statistically significant differences in general data among groups A,B and C(P>0.05),and the baseline data were comparable.The total effective rate of group C(93.33%)was significantly higher than that of group B(80.00%)and group A(66.67%),with a statistically significant difference(P=0.023).Before treatment,there were no significant differences among the three groups in GCSI scores,gastrointestinal motility indicators,gastrointestinal hormone levels,electrogastrography indicators,and heart rate variability indicators(all P>0.05).After treatment,the GCSI scores of all three groups decreased significantly(all P<0.001),with group C showing the greatest improvement.The gastric emptying time of all three groups was shortened,the gastric emptying rate increased,and the antral contraction frequency rose.Moreover,the improvements in these indicators in group C were more significant than those in groups A and B(all P<0.001).The levels of gastrin and motility in group C were significantly higher,while the level of somatostatin was significantly lower than those in groups A and B(all P<0.001).The values of PDP and PDF in all three groups increased significantly,and those in group C were significantly higher than those in groups A and B(all P<0.05).SDANN,RMSSD,and SDNN in group C were significantly higher,and LF/HF was significantly lower than those in groups A and B(all P<0.001).There was no statistically significant difference in the total incidence of adverse reactions among the three groups(P>0.05).Conclusion Extracorporeal shock wave stimulation of Zusanli acupoint combined with Jianyu acupoint in the treatment of GDP can significantly improve the clinical efficacy,effectively improve the gastrointestinal motility and autonomic nerve function of patients.
作者
赵金凤
王凌毅
姜东春
Zhao Jinfeng;Wang Lingyi;Jiang Dongchun(Department of Comprehensive Assessment and Treatment,Hebei Rehabilitation Hospital,Qinhuangdao 066199,China;Department of Rehabilitation and Physiotherapy,First Hospital of Qinhuangdao,Qinhuangdao 066199,China;Third Department of Gastroenterology,First Hospital of Qinhuangdao,Qinhuangdao 066199,China)
出处
《中华消化病与影像杂志(电子版)》
2025年第5期539-545,共7页
Chinese Journal of Digestion and Medical Imageology(Electronic Edition)
基金
河北省医学科学研究课题(20181200)
秦皇岛市科学技术研究与发展计划自筹经费项目(202301A098)。
关键词
糖尿病性胃轻瘫
体外冲击波
足三里
肩髃
胃肠动力
自主神经功能
Diabetic gastroparesis
Extracorporeal shock wave
Zusanli acupoint
Jianyu acupoint
Gastrointestinal motility
Autonomic nervous function
