Montejo González J C, Estébanez Montiel B
Medicina Intensiva, Unidad Polivalente, Hospital 12 de Octubre, Madrid, España.
Nutr Hosp. 2007 May;22 Suppl 2:56-62.
Critically ill patients may have gastrointestinal complications during hospital stay. The most clinically important complications are gastrointestinal hemorrhage and enteral nutrition-related complications. Currently, gastrointestinal hemorrhage is uncommon due to the use of medication protecting the gastric mucosa and the increasingly frequent use of enteral nutrition. Although GI hemorrhage makes necessary the modification of the type of nutritional support until the bleeding is under control, there are situations in which the hemorrhage does note necessarily imply fasting. Among enteral nutrition-related complications, the increase in gastric residue is the most frequent one. This high frequency is due to impairments in gastric motility induced by severe disease itself and therapeutic measures applied to patients, such the medication administered. The use of pro-kinetic drugs seems to be a useful measure for preventing and treating the increase in gastric residue, although in refractory cases transpyloric nutrition may be necessary. The presence of gastrointestinal complications has a negative effect on the amount of diet administered to the patients, with subsequent increase in infectious complications, hospital stay, and mortality. The use of identification protocols and appropriate management of gastrointestinal complications in critically ill patients may be beneficial in their clinical course.
危重症患者在住院期间可能会出现胃肠道并发症。临床上最重要的并发症是胃肠道出血和肠内营养相关并发症。目前，由于使用胃黏膜保护药物以及肠内营养的使用日益频繁，胃肠道出血并不常见。尽管胃肠道出血使得在出血得到控制之前有必要调整营养支持的类型，但在某些情况下，出血并不一定意味着要禁食。在肠内营养相关并发症中，胃残余量增加是最常见的。这种高发生率是由于严重疾病本身以及应用于患者的治疗措施（如所使用的药物）导致的胃动力受损。使用促动力药物似乎是预防和治疗胃残余量增加的有效措施，尽管在难治性病例中可能需要经幽门营养。胃肠道并发症的出现会对给予患者的饮食量产生负面影响，进而增加感染性并发症、住院时间和死亡率。在危重症患者中使用识别方案并对胃肠道并发症进行适当管理可能对其临床病程有益。
