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Small bowel resistances and the gastroduodenal brake.

机译:小肠阻力和胃十二指肠制动。

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摘要

Osmoreceptors in the upper small bowel may delay gastric emptying by inhibiting fundal tone and/or by increasing outflow resistances. In this study we examined the contribution of postpyloric resistances to this braking system. Seven dogs had gastric emptying of 250 ml 15% dextrose, labelled with 99mTc-DTPA, measured by gamma camera imaging (preoperative studies: n = 21). A proximal duodenal cannula was inserted and studies repeated in four modes: with the cannula closed (n = 14); with total diversion of gastric effluent through the cannula (n = 7); with diversion and downstream reinstillation of effluent at a constant rate (n = 14) equivalent to emptying calculated from studies without diversion; and with diversion and total reinstillation of effluent (n = 14). Gastric emptying at 90 minutes was similar in preoperative studies (48 +/- 5% - mean +/- SEM) and in those with the cannula closed (50 +/- 3%). By comparison 'total diversion' produced rapid emptying over 90 minutes (97 +/- 1%; p less than 0.001). Reinstillation of effluent at a constant rate reduced the 90 minute emptying to 59 +/- 6%, and total reinstillation slowed emptying further to 37 +/- 4% (p less than 0.05). Neither reinstillation protocol yielded gastric emptying rates that were significantly different from those in studies without diversion. With total reinstillation, emptying and hence reinstillation rates were more variable, proceeding in a step and plateau fashion. We conclude that canine jejunal osmoreceptor activity is mediated through the stomach, with postpyloric resistances playing little or no role. Gastric emptying curve analysis suggested that increments of rapid small bowel filling provoke exaggerated braking responses.
机译:小肠上部的渗透压感受器可通过抑制眼底张力和/或增加流出阻力来延迟胃排空。在这项研究中,我们检查了幽门后阻力对该制动系统的贡献。七只狗的胃排空量为250 ml 15%右旋糖,标有99mTc-DTPA,通过伽玛相机成像测量(术前研究:n = 21)。插入十二指肠近端套管并以四种方式重复研究:套管闭合(n = 14);通过套管使胃液完全转移(n = 7);进行分流,并以恒定速率(n = 14)进行下游废水再滴入,相当于不进行分流研究得出的排空量;并进行分流和再注入废水(n = 14)。术前研究(48 +/- 5%-平均值+/- SEM)和套管闭合(50 +/- 3%)的患者在90分钟时的胃排空相似。相比之下,“全部转移”可在90分钟内快速排空(97 +/- 1%; p小于0.001)。以恒定的速率重新滴注将90分钟的排空速度降低到59 +/- 6%,并且完全重新滴注将放空的速度进一步减慢至37 +/- 4%(p小于0.05)。两种再灌注方案均未产生与未转移的研究中的胃排空率显着不同。在完全重新滴注的情况下,排空和因此的重新滴注速率更具可变性,以逐步和平稳的方式进行。我们得出结论,犬空肠渗透压感受器的活性是通过胃来介导的,幽门后抵抗起的作用很小或没有作用。胃排空曲线分析表明,快速的小肠充盈增加会引起夸张的制动反应。

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