López-Herce Jesús
Pediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Curr Opin Clin Nutr Metab Care. 2009 Mar;12(2):180-5. doi: 10.1097/MCO.0b013e3283218285.
The objective of this review has been to analyse and compare the causes, incidence, severity and treatment of gastrointestinal complications in critically ill children and adults.
The incidence of gastrointestinal complications in critically ill patients published in the literature is very variable owing to the absence of unified diagnostic criteria both in children and adults. The incidence of gastrointestinal complications related to nutrition appears to be lower in children than in adults, and there are no differences in the incidence of gastrointestinal complications between gastric and transpyloric nutrition except with respect to the volume of gastric residues. The most important risk factors for digestive tract complications are shock and the administration of drugs (catecholamines, sedatives and muscle relaxants). Altered gastrointestinal motility is the principal mechanism underlying an excessive gastric residue, abdominal distension and constipation.
Gastrointestinal complications limit the efficacy of enteral nutrition in the critically ill patient and can affect morbidity and mortality. Consensus must be reached on the definition of the criteria of excessive gastric residues, constipation and diarrhoea, and studies must be performed that evaluate the efficacy of prokinetic agents on altered gastrointestinal motility and the effects of diet and laxatives on constipation in the critically ill adult and child.
本综述旨在分析和比较危重症儿童与成人胃肠道并发症的病因、发病率、严重程度及治疗方法。
由于儿童和成人均缺乏统一的诊断标准，文献中报道的危重症患者胃肠道并发症发病率差异很大。与营养相关的胃肠道并发症发病率在儿童中似乎低于成人，胃内营养和经幽门营养的胃肠道并发症发病率除胃残余量外无差异。消化道并发症最重要的危险因素是休克和药物（儿茶酚胺、镇静剂和肌肉松弛剂）的使用。胃肠动力改变是胃残余量过多、腹胀和便秘的主要潜在机制。
胃肠道并发症限制了危重症患者肠内营养的效果，并可能影响发病率和死亡率。必须就胃残余量过多、便秘和腹泻的标准定义达成共识，并且必须开展研究，评估促动力药物对胃肠动力改变的疗效以及饮食和泻药对危重症成人和儿童便秘的影响。
