Tamion Fabienne, Hamelin Karine, Duflo Annie, Girault Christophe, Richard Jean-Christophe, Bonmarchand Guy
Medical Intensive Care Unit, Hospital Charles Nicolle, Rouen University, 1 rue de Germont, 76031 Rouen, France.
Intensive Care Med. 2003 Oct;29(10):1717-22. doi: 10.1007/s00134-003-1898-5. Epub 2003 Jul 30.
To assess gastrointestinal function in critically ill patients receiving muscle relaxant and to test clinical tolerance to enteral nutrition.
Prospective study in an intensive care unit.
20 critically ill patients requiring sedation with muscle relaxant to obtain adequate mechanical ventilation.
Patients were randomly selected to receive infusions of opioid sedation during the first session (session 1) and the same sedation with muscle relaxation (cisatracurium) during the second session (session 2). Gastric emptying was assessed by the paracetamol absorption technique. Following the paracetamol absorption 200 ml enteral feed was given, and the residual gastric volume was measured 1 and 2 h after feeding. The maximum plasma concentration (Cmax) was 14 mg/l (range 5-26) when patients received sedation, and 12 mg/l (range 5-30) when they received muscle relaxant. The target time for reaching the maximum plasma concentration (Tmax) was 30 min (range 20-60) and 35 min (range 20-60), respectively, in sessions 1 and 2. There was no significant difference between the two session as regards Tmax, Cmax, or AUC(0-120). The residual volumes were 110+/-65 ml (H1) and 95+/-76 ml (H2) during session 1 and 125+/-85 ml (H1) and 105+/-90 ml (H2) during session 2.
Enteral feeding is one of the most effective methods of supporting nutritional needs in the critically ill patient. We conclude that in critically ill patients requiring sedation gastric emptying is not improved by neuromuscular blocking agent.
评估接受肌肉松弛剂治疗的危重症患者的胃肠功能，并测试其对肠内营养的临床耐受性。
在重症监护病房进行的前瞻性研究。
20例需要使用肌肉松弛剂进行镇静以实现充分机械通气的危重症患者。
患者被随机选择在第一阶段（阶段1）接受阿片类镇静剂输注，并在第二阶段（阶段2）接受相同的镇静加肌肉松弛（顺式阿曲库铵）。通过对乙酰氨基酚吸收技术评估胃排空情况。在对乙酰氨基酚吸收后给予200 ml肠内营养，喂食后1小时和2小时测量胃残余量。患者接受镇静时最大血浆浓度（Cmax）为14 mg/l（范围5 - 26），接受肌肉松弛剂时为12 mg/l（范围5 - 30）。在阶段1和阶段2中，达到最大血浆浓度的目标时间（Tmax）分别为30分钟（范围20 - 60）和35分钟（范围20 - 60）。在Tmax、Cmax或AUC(0 - 120)方面，两个阶段之间没有显著差异。阶段1期间胃残余量为110±65 ml（H1）和95±76 ml（H2），阶段2期间为125±85 ml（H1）和105±90 ml（H2）。
肠内营养是满足危重症患者营养需求的最有效方法之一。我们得出结论，对于需要镇静的危重症患者，神经肌肉阻滞剂并不能改善胃排空。
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