Röhm Kerstin D, Boldt Joachim, Piper Swen N
Department of Anaesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen, Ludwigshafen, Germany.
Curr Opin Clin Nutr Metab Care. 2009 Mar;12(2):161-7. doi: 10.1097/MCO.0b013e32832182c4.
Motility disturbances often occur in critically ill patients resulting in an increased rate of morbidity and mortality. Only limited options for treatment of gastrointestinal dysfunction have been introduced. Factors contributing to motility disorders in the ICU patient, and recent therapeutic approaches are reviewed in the following.
Despite the growing use of early enteral nutrition in the ICU and improvements in patients' outcome, feed intolerance and motility disorders in critical illness remain unsolved. Evaluation of pathophysiological patterns such as antro-pyloric dysfunction has led to a better knowledge of gut function, whereas development of new prokinetic agents is scarce, and enthusiasm has been cut by the withdrawal of some propulsive agents from the market.
The complexity of gastrointestinal motor function poses a challenge to the pharmacological modulation of gut motility. There has been progress in the understanding of pathophysiologic patterns, whereas therapeutic options are still rare. Metoclopramide and erythromycin are the best evaluated and still the most promising prokinetic agents. Only a few studies in critical illness are available, and the definite value of novel propulsive agents such as motilin agonists and mu-receptor antagonists is unclear due to small patient populations. The most reasonable approach of motility disorders in critical illness seems to be an individual assessment of all associated risk factors combined with early enteral nutrition and use of prokinetic agents.
重症患者常出现胃肠动力障碍，导致发病率和死亡率上升。目前针对胃肠功能障碍的治疗选择有限。本文将对重症监护病房（ICU）患者发生动力障碍的相关因素及近期的治疗方法进行综述。
尽管ICU中早期肠内营养的使用日益增多，且患者预后有所改善，但危重症患者的喂养不耐受和动力障碍问题仍未解决。对诸如胃窦 - 幽门功能障碍等病理生理模式的评估有助于更好地了解肠道功能，然而新型促动力药物的研发却很匮乏，并且一些促动力药物退出市场也削弱了人们的积极性。
胃肠运动功能的复杂性给肠道动力的药物调节带来了挑战。在病理生理模式的理解方面取得了进展，但治疗选择仍然很少。甲氧氯普胺和红霉素是评估最充分且最具前景的促动力药物。关于危重症患者的研究较少，由于患者数量少，胃动素激动剂和μ受体拮抗剂等新型促动力药物的确切价值尚不清楚。对于危重症患者动力障碍最合理的处理方法似乎是对所有相关危险因素进行个体化评估，同时结合早期肠内营养和使用促动力药物。
