红霉素可减少重症创伤患者的胃排空延迟：一项随机对照试验。

Erythromycin reduces delayed gastric emptying in critically ill trauma patients: a randomized, controlled trial.

作者信息

Berne John D, Norwood Scott H, McAuley Clyde E, Vallina Van L, Villareal David, Weston Jaye, McClarty Jerry

机构信息

Division of Trauma Services, East Texas Medical Center, Tyler, USA.

出版信息

J Trauma. 2002 Sep;53(3):422-5. doi: 10.1097/00005373-200209000-00004.

DOI:10.1097/00005373-200209000-00004

PMID:12352474

Abstract

BACKGROUND

Early enteral feeding has been shown to be beneficial in improving outcome in critically injured trauma patients. Delayed gastric emptying occurs frequently in trauma patients, increasing the time to achieve nutritional goals, and limiting the benefit of early enteral feedings. Intravenous erythromycin is an effective agent for improving gastric motility in diabetics and postgastrectomy patients. The purpose of this study is to determine the effectiveness of erythromycin for improving gastric motility in critically injured trauma patients.

METHODS

All critically injured patients who received gastric feedings within 72 hours of admission were candidates for the study. Those patients who failed to tolerate feedings at 48 hours (gastric residual > 150 mL) were eligible for enrollment. Patients were prospectively assigned to two treatment groups by randomization to receive either erythromycin (ERY) or placebo (PLA). Treatment was continued in patients who tolerated gastric feedings until the feedings were no longer required. Patients with continued intolerance for 48 hours after randomization were considered failures of therapy and given metoclopramide.

RESULTS

Sixty-eight patients were enrolled and were well matched for age, sex, and Injury Severity Score. Mortality, intensive care unit length of stay, hospital length of stay, number of ventilator days, and rate of nosocomial infections were similar in each group. There was a significant difference between the ERY group and the PLA group in the amount of feedings tolerated at 48 hours (58% vs. 44%, p = 0.001). There was no difference in the amount of feedings tolerated (as a percentage of target goal volume) throughout the entire duration of the study (ERY [65% of target] vs. PLA [59%], p = 0.061). Overall success of therapy at 48 hours was 56% in the ERY group versus 39% in the PLA group, but this also did not reach statistical significance (p = 0.22).

CONCLUSION

Intravenous erythromycin improves gastric motility and enhances early nutritional intake in critically injured patients.

摘要

背景

早期肠内喂养已被证明有助于改善重症创伤患者的预后。创伤患者经常出现胃排空延迟，这增加了实现营养目标的时间，并限制了早期肠内喂养的益处。静脉注射红霉素是改善糖尿病患者和胃切除术后患者胃动力的有效药物。本研究的目的是确定红霉素对改善重症创伤患者胃动力的有效性。

方法

所有在入院72小时内接受胃内喂养的重症患者均为该研究的候选对象。那些在48小时内不能耐受喂养（胃残余量>150毫升）的患者符合入选条件。患者通过随机分组前瞻性地分为两个治疗组，分别接受红霉素（ERY）或安慰剂（PLA）治疗。能够耐受胃内喂养的患者持续接受治疗，直至不再需要喂养。随机分组后持续48小时不耐受的患者被视为治疗失败，并给予甲氧氯普胺治疗。

结果

68名患者入组，在年龄、性别和损伤严重程度评分方面匹配良好。每组的死亡率、重症监护病房住院时间、住院时间、呼吸机使用天数和医院感染率相似。ERY组和PLA组在48小时时耐受的喂养量有显著差异（58%对44%，p = 0.001）。在整个研究期间，耐受的喂养量（占目标量的百分比）没有差异（ERY组为目标量的65%，PLA组为59%，p = 0.061）。ERY组在48小时时的总体治疗成功率为56%，PLA组为39%，但这也未达到统计学意义（p = 0.22）。