Department of Intensive Care, Austin Hospital, Melbourne, VIC.
Crit Care Resusc. 2010 Sep;12(3):182-5.
Limited information exists on the factors affecting bowel motions and the physical characteristics of stools in mechanically ventilated patients in the intensive care environment. We hypothesised that most stools in critically ill patients are not formed and that both diarrhoea and non-defecation are common.
DESIGN, SETTING AND PATIENTS: Pilot prospective observational study of 44 patients in a tertiary intensive care unit who were mechanically ventilated for more than 24 hours.
We collected data on the frequency and appearance (Bristol stool chart) of bowel motions, and administration of nutrition, narcotics, anti-emetics, prokinetics and laxatives.
Forty-four patients (31 male) with a mean age of 60.3 years were monitored for 274 ventilation days. There were 168 days (61.3%) with no defecation. During the 106 days (38.8%) with bowel motions, there were 101 days (36.9%) with loose stools and 33 days (12.0%) with at least one episode of diarrhoea. Formed stools were present on only 5 days (1.8%). No patients developed clinical or radiological evidence of constipation or pseudoobstruction. Treatment with lactulose (P = 0.009) and ondansetron (P = 0.02) was associated with a day with bowel motions, while use of morphine (P = 0.025) was associated with non-defecation. Lactulose treatment was the only factor associated with stool volume (P < 0.001). A higher rate of enteral nutrition was associated with looser stools (P < 0.001), while morphine was negatively associated with looser stools (P < 0.001).
Among patients receiving mechanical ventilation for more than 24 hours, lack of bowel motions (non-defecation) was the most common physiological state. However, diarrhoea was also relatively common, and formed stools were rare.
在重症监护环境中，接受机械通气的患者的肠道运动和粪便物理特性的影响因素的相关信息有限。我们假设大多数危重症患者的粪便未成形，腹泻和不排便均很常见。
设计、地点和患者：对在三级重症监护病房接受机械通气超过 24 小时的 44 例患者进行的前瞻性观察性研究。
我们收集了关于排便频率和外观（布里斯托粪便图表）、营养、麻醉剂、止吐药、促动力药和泻药的使用情况的数据。
44 例（31 例男性）患者的平均年龄为 60.3 岁，共监测了 274 个通气日。有 168 天（61.3%）没有排便。在 106 天（38.8%）有排便的日子里，有 101 天（36.9%）有稀便，33 天（12.0%）至少有一次腹泻。成形的粪便仅存在于 5 天（1.8%）。没有患者出现便秘或假性肠梗阻的临床或影像学证据。使用乳果糖（P = 0.009）和昂丹司琼（P = 0.02）与排便日有关，而使用吗啡（P = 0.025）与不排便有关。乳果糖治疗是唯一与粪便量相关的因素（P < 0.001）。更高的肠内营养率与更稀的粪便有关（P < 0.001），而吗啡与更稀的粪便呈负相关（P < 0.001）。
在接受超过 24 小时机械通气的患者中，缺乏肠道运动（不排便）是最常见的生理状态。然而，腹泻也相对常见，成形的粪便很少见。
