Department of Anesthesiology and Intensive Care Medicine, Division of Anesthesiology for Cardiovascular Surgery and Intensive Care Medicine, Medical University of Graz, Graz, Austria.
Curr Opin Crit Care. 2010 Apr;16(2):159-64. doi: 10.1097/MCC.0b013e3283356679.
Early detection of gastrointestinal motility disturbances is a major goal to reduce the incidence of this potentially disastrous event by prophylactic managements and early goal-directed therapy in patients at risk.
Gastroparesis frequently results in the inability to feed critically ill patients, aggravating problems such as bacterial translocation and stress-induced intestinal damage. Recently published data have advanced our understanding of the pathophysiologic background of gastroparesis, intestinal stress damage and the effect of early enteral nutrition on gastrointestinal function. New techniques, such as ultrasound and the capsule techniques, might help to assess intestinal function beyond the aspiration of gastric residual volumes and the passage of stool. Therapeutic options such as opioid antagonists and the 5-hydroxytryptamine receptor 4 agonist prucalopride might help to restore intestinal function.
Gastrointestinal motility disturbances are caused by a myriad of pathological processes. Moreover, bowel integrity is governed by comorbidity, impaired metabolic function and pharmacological interventions in critically ill patients. Restoring gastrointestinal function, therefore, requires a multimodal approach including prophylactic management strategies and the sensible use of substances with inhibitory effects on intestinal motility.
早期发现胃肠道动力障碍是通过预防治疗和对有风险的患者进行早期目标导向治疗，降低这种潜在灾难性事件发生率的主要目标。
胃轻瘫常导致重症患者无法进食，加重细菌易位和应激引起的肠道损伤等问题。最近发表的数据提高了我们对胃轻瘫、肠道应激损伤以及早期肠内营养对胃肠道功能影响的病理生理背景的理解。新的技术，如超声和胶囊技术，可能有助于评估胃肠道功能，而不仅仅是抽吸胃残留量和粪便通过情况。阿片受体拮抗剂和 5-羟色胺受体 4 激动剂普芦卡必利等治疗选择可能有助于恢复肠道功能。
胃肠道动力障碍是由多种病理过程引起的。此外，肠道完整性还受到合并症、代谢功能受损和重症患者药物干预的影响。因此，恢复胃肠道功能需要采用多模式方法，包括预防治疗策略和合理使用具有抑制肠道动力作用的物质。
