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机械通气的危重症患者对持续肠内喂养的十二指肠运动反应受损。

Duodenal motor response to continuous enteral feeding is impaired in mechanically ventilated critically ill patients.

作者信息

Dive A, Miesse C, Jamart J, Evrard P, Gonzalez M, Installe E

机构信息

Department of Biostatistics, Mont-Godinne University Hospital, Louvain School of Medicine, B-5530 Yvoir, Belgium.

出版信息

Clin Nutr. 1994 Oct;13(5):302-6. doi: 10.1016/0261-5614(94)90053-1.

Abstract

In order to investigate the duodenal motor response to continuous enteral feeding during critical illness, we recorded the duodenal contractions of 12 mechanically ventilated critically ill patients during a 4 h fasting period immediately followed by another 4 h period of continuous (100 kcal/h) nasogastric feeding with a polymeric diet. Duodenal motility was recorded by manometry (perfused catheter technique) and the migrating motor complexes (MMC) were identified by their activity front (period of high frequency, regular contractions). The incidence and the mean duration of activity fronts as well as the mean duration of the MMC (time interval separating two successive activity fronts) recorded during both periods were compared. The incidence of activity fronts (fasting: median: 2.5, interquartile range: 5.5; feeding: median: 2, interquartile range: 3.5), their duration (fasting: 6.2 +/- 1.6 min; feeding: 5.8 +/- 1.6 min), and the mean duration of the MMC (fasting: 50.9 +/- 24.7 min; feeding: 49.1 +/- 20.3 min) were similar during both periods. We conclude that in these patients, the fasting pattern of motility is not interrupted by the continuous nasogastric administration of a polymeric diet. Since the activity fronts of the MMCs are highly propulsive, we suggest that their abnormal persistence during feeding may play a role in the pathophysiology of unexplained diarrhoea in some critically ill patients.

摘要

为了研究危重症期间十二指肠对持续肠内喂养的运动反应,我们记录了12例机械通气的危重症患者在禁食4小时期间以及随后连续4小时经鼻胃管输注(100千卡/小时)聚合膳的十二指肠收缩情况。通过测压法(灌注导管技术)记录十二指肠运动,并通过其活动前沿(高频、规则收缩期)识别移行运动复合波(MMC)。比较了两个时期记录的活动前沿的发生率和平均持续时间以及MMC的平均持续时间(两个连续活动前沿之间的时间间隔)。两个时期活动前沿的发生率(禁食:中位数:2.5,四分位数间距:5.5;喂养:中位数:2,四分位数间距:3.5)、其持续时间(禁食:6.2±1.6分钟;喂养:5.8±1.6分钟)以及MMC的平均持续时间(禁食:50.9±24.7分钟;喂养:49.1±20.3分钟)相似。我们得出结论,在这些患者中,禁食时的运动模式不会被经鼻胃管持续给予聚合膳所打断。由于MMC的活动前沿具有高度推进性,我们认为其在喂养期间的异常持续可能在一些危重症患者不明原因腹泻的病理生理学中起作用。

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