van der Spoel Johan I, Schultz Marcus J, van der Voort Peter H J, de Jonge Evert
Onze Lieve Vrouwe Gasthuis, Department of Intensive Care, Oosterpark 9, 1091 AC Amsterdam, The Netherlands.
Intensive Care Med. 2006 Jun;32(6):875-80. doi: 10.1007/s00134-006-0175-9. Epub 2006 Apr 28.
To describe the pattern of defecation in critically ill ventilated patients and the influence of selective decontamination (SDD) and other medication.
Descriptive cohort study.
Mixed surgical-medical ICU in a university Hospital.
Ventilated patients with a length of stay >or=7 days taking part in a study on SDD.
Daily registration of defecation, SOFA (sepsis-related organ failure assessment score) score, administration of dopamine, noradrenaline, morphine and other medications.
The first defecation occurred after a mean of 6.2 days. Patients with defecation within 6[Symbol: see text]days had lower mean SOFA scores, received more cisapride and lactulose and less dopamine, noradrenaline and morphine, and had a shorter duration of mechanical ventilation and ICU stay. On 57% of the days, no stools were produced; on 31% diarrhea, and on 12%, normal stools. Patients receiving SDD had more days with normal stools and less with diarrhea. Diarrhea was preceded by the administration of lactulose in the majority of patients.
Time to first defecation correlated with severity of illness, vasoactive medication, administration of morphine, cisapride and lactulose, duration of mechanical ventilation and length of stay. Diarrhea seemed at least partially iatrogenic.
描述重症机械通气患者的排便模式以及选择性消化道去污（SDD）和其他药物的影响。
描述性队列研究。
一所大学医院的外科-内科混合重症监护病房。
入住时间≥7天的机械通气患者，参与一项关于SDD的研究。
每日记录排便情况、序贯器官衰竭评估（SOFA）评分、多巴胺、去甲肾上腺素、吗啡及其他药物的使用情况。
首次排便平均发生在6.2天后。在6天内排便的患者平均SOFA评分较低，接受西沙必利和乳果糖的剂量更多，而多巴胺、去甲肾上腺素和吗啡的剂量更少，机械通气时间和重症监护病房住院时间更短。57%的日子没有排便；31%出现腹泻，12%排便正常。接受SDD的患者排便正常的天数更多，腹泻的天数更少。大多数患者腹泻前使用过乳果糖。
首次排便时间与疾病严重程度、血管活性药物、吗啡、西沙必利和乳果糖的使用、机械通气时间和住院时间相关。腹泻似乎至少部分是医源性的。
