Reintam Blaser Annika, Deane Adam M, Fruhwald Sonja
aDepartment of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland bDepartment of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia cDepartment of Critical Care Services, Royal Adelaide Hospital, Adelaide dDiscipline of Acute Care Medicine, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia eDepartment of Anesthesiology and Intensive Care Medicine, Division of Anaesthesiology for Cardiovascular Surgery and Intensive Care Medicine, Medical University of Graz, Graz, Austria.
Curr Opin Crit Care. 2015 Apr;21(2):142-53. doi: 10.1097/MCC.0000000000000188.
To summarize existing evidence on definition, epidemiology, mechanisms, risk factors, consequences, outcome and management of diarrhoea in the critically ill.
In health, diarrhoea is defined as the passage of three or more loose or liquid stools per day. In the critically ill, the diagnosis is yet to be formalized and reported prevalence of diarrhoea varies according to the definition used. Recent studies estimate the prevalence between 14 and 21% and describe risk factors for diarrhoea in critically ill patients. The precipitant of diarrhoea always needs to be identified, as targeted therapies are important for several causes. Although the majority of patients with diarrhoea require only supportive care, it is always essential to exclude, or confirm and treat infectious diarrhoea. There is little evidence to support delaying or withdrawing provision of enteral nutrition in patients with diarrhoea, and we recommend continuing enteral nutrition whenever possible. However, the consequences of diarrhoea - hypovolaemia, electrolyte disturbances, malnutrition, skin lesions and contamination of wounds - should be avoided or at least recognized promptly.
A definition of diarrhoea and a practical approach to identify the precipitant and to manage diarrhoea in critically ill patients are proposed.
总结关于危重症患者腹泻的定义、流行病学、机制、危险因素、后果、结局及管理的现有证据。
在健康状态下，腹泻定义为每天排出三次或更多稀便或水样便。在危重症患者中，腹泻的诊断尚未规范化，且腹泻的报告患病率因所采用的定义而异。近期研究估计患病率在14%至21%之间，并描述了危重症患者腹泻的危险因素。腹泻的诱因总是需要确定的，因为针对多种病因的靶向治疗很重要。虽然大多数腹泻患者仅需支持治疗，但排除、确认并治疗感染性腹泻始终至关重要。几乎没有证据支持对腹泻患者延迟或停止提供肠内营养，我们建议尽可能持续进行肠内营养。然而，应避免腹泻的后果——低血容量、电解质紊乱、营养不良、皮肤损伤及伤口污染——或至少及时识别。
提出了腹泻的定义以及识别危重症患者腹泻诱因和管理腹泻的实用方法。
