Wiesen Patricia, Van Gossum André, Preiser Jean-Charles
Department of Intensive Care, Centre Hospitalier, Universitaire du Sart Tilman, Liège, Belgium.
Curr Opin Crit Care. 2006 Apr;12(2):149-54. doi: 10.1097/01.ccx.0000216583.64804.46.
The purpose of this review is to update the knowledge on diarrhoea, a common problem in critically ill patients. Epidemiological data will be discussed, with special emphasis on diarrhoea in tube-fed patients and during antibiotic therapy. The possible preventive and therapeutic measures will be presented.
The need for concise definitions of diarrhoea was recently re-emphasized. The use of pump-driven continuous instead of intermittent enteral feeding is less often associated with diarrhoea. The discontinuation of enteral feeding during diarrhoea is not justified. Clostridium difficile-associated diarrhoea is frequent during antibiotic therapy with quinolones and cephalosporins. Formulas enriched with water-soluble fibres are probably effective to prevent diarrhoea, and promising data on the modulation of gut microflora with probiotics and prebiotics were recently released.
Diarrhoea is common in critically ill patients, especially when sepsis and hypoalbuminaemia are present, and during enteral feeding and antibiotic therapy. The management of diarrhoea includes generous hydration, compensation for the loss of electrolytes, antidiarrheal oral medications, the continuation of enteral feeding, and metronidazole or glycopeptides in the case of moderate to severe C. difficile colitis. The place of enteral formulas enriched with water-soluble fibres, probiotics and prebiotics is not yet fully defined.
本综述旨在更新关于腹泻这一危重症患者常见问题的知识。将讨论流行病学数据，特别强调管饲患者及抗生素治疗期间的腹泻情况。还将介绍可能的预防和治疗措施。
近期再次强调了对腹泻进行简洁定义的必要性。使用泵驱动的持续肠内喂养而非间歇肠内喂养与腹泻的关联较少。腹泻期间停用肠内喂养并无依据。在使用喹诺酮类和头孢菌素进行抗生素治疗期间，艰难梭菌相关性腹泻较为常见。富含水溶性纤维的配方可能对预防腹泻有效，并且近期公布了关于益生菌和益生元调节肠道微生物群的有前景的数据。
腹泻在危重症患者中很常见，尤其是存在脓毒症和低白蛋白血症时，以及在肠内喂养和抗生素治疗期间。腹泻的管理包括充分补液、补充电解质丢失、使用止泻口服药物、继续肠内喂养，以及对于中度至重度艰难梭菌结肠炎使用甲硝唑或糖肽类药物。富含水溶性纤维、益生菌和益生元的肠内配方的作用尚未完全明确。
