[红霉素与甲氧氯普胺治疗重症监护病房危重症患者喂养不耐受的研究]

[Study of erythromycin and metoclopramide in treatment of feeding intolerance of critically ill patients in intensive care unit].

作者信息

Lu Nian-Fang, Zheng Rui-Qiang, Lin Hua, Yang De-Gang, Chen Qi-Hong, Shao Jun, Yu Jiang-Quan

机构信息

Intensive Care Unit, Subei People's Hospital of Jiangsu Province, Clinical Medical School of Yangzhou University, Yangzhou 225001, Jiangsu, China.

出版信息

Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2010 Jan;22(1):36-9.

PMID:20092709

Abstract

OBJECTIVE

To compare the effect of erythromycin and metoclopramide on feeding intolerance of critically ill patients in intensive care unit (ICU).

METHODS

One hundred and fifty-two critically ill patients in ICU who needed early enteral nutrition exceeding 7 days between January 2007 and January 2009 were included in the study. The patients were randomly divided into three groups: erythromycin group (200 mg intravenous drip, once every 12 hours), metoclopramide group (10 mg intravenous injection, once every 8 hours), and combination therapy group. The whole experiment was carried out for 7 days. Residual gastric volume was aspirated and measured every day at 03:00, 09:00, 15:00 and 21:00. The daily mean gastric residual volume was compared. At the same time, the daily effectiveness of erythromycin and metoclopramide on the success of feeding was also compared. The factors associated with a poor response to prokinetic therapy were looked for.

RESULTS

The daily gastric residual volume in the combination therapy group was smallest, the maximum was (40+/-8) ml; the maximum of gastric residual volume in erythromycin group was (42+/-7) ml; the maximum of gastric residual volume in metoclopramide group was (59+/-8) ml (P<0.05 or P<0.01). The successful rate of feeding was highest in the combination therapy group, and it was as high as 97.4%, the erythromycin group ranked the second (90.0%), and that of the metoclopramide group was lowest (89.5%, P<0.05 or P<0.01). Factors that were associated with a poor response to prokinetic therapy was high pretreatment 24-hour gastric residual volume (r=-0.584, P=0.000), high blood sugar level (r=-0.345, P=0.029), a high acute physiology and chronic health evaluation II (APACHEII) score (r=-0.437, P=0.005), and requirement for inotropic drug support (r=-0.389, P=0.041).

CONCLUSION

Low dose of erythromycin could improve the successful rate of feeding in critically ill patients in ICU. The combined administration of erythromycin and metoclopramide was more effective. Its side effect was minimal.

摘要

目的

比较红霉素与甲氧氯普胺对重症监护病房（ICU）危重症患者喂养不耐受的影响。

方法

纳入2007年1月至2009年1月期间在ICU需要早期肠内营养超过7天的152例危重症患者。将患者随机分为三组：红霉素组（200mg静脉滴注，每12小时1次）、甲氧氯普胺组（10mg静脉注射，每8小时1次）和联合治疗组。整个实验持续7天。每天03:00、09:00、15:00和21:00抽吸并测量胃残余量。比较每日平均胃残余量。同时，比较红霉素和甲氧氯普胺每日对喂养成功的有效性。寻找与促动力治疗反应不佳相关的因素。

结果

联合治疗组每日胃残余量最小，最大值为（40±8）ml；红霉素组胃残余量最大值为（42±7）ml；甲氧氯普胺组胃残余量最大值为（59±8）ml（P<0.05或P<0.01）。联合治疗组喂养成功率最高，高达97.4%，红霉素组排第二（90.0%），甲氧氯普胺组最低（89.5%，P<0.05或P<0.01）。与促动力治疗反应不佳相关的因素有预处理时24小时胃残余量高（r=-0.584，P=0.000）、血糖水平高（r=-0.345，P=0.029）、急性生理与慢性健康状况评价II（APACHEII）评分高（r=-0.437，P=0.005）以及需要血管活性药物支持（r=-0.389，P=0.041）。