经口喂养及血清胃饥饿素水平对危重症患者的影响：一项初步研究。
Effects of Rikkunshito (traditional Japanese medicine) on enteral feeding and the plasma ghrelin level in critically ill patients: a pilot study.
机构信息
Emergency and Critical Care Center, Hokkaido University Hospital, N14W5 Kita-ku, Sapporo, 060-8648 Japan.
Gastroenterology and Hematology, Hokkaido University Graduate School of Medicine, Sapporo, 060-8638 Japan.
出版信息
J Intensive Care. 2014 Sep 2;2(1):53. doi: 10.1186/s40560-014-0053-4. eCollection 2014.
BACKGROUND
Rikkunshito is a traditional Japanese medicine that has been widely prescribed for patients with various gastrointestinal symptoms. Recently, the prokinetic effects of Rikkunshito in patients with a variety of diseases have attracted attention in Japan. The prokinetic effects of Rikkunshito are believed to result from an increase of active ghrelin, which is most abundant in the stomach and which has a gastrokinetic function. The aim of the present pilot study was to investigate the effects of Rikkunshito on intragastric enteral feeding and plasma ghrelin levels in critically ill patients.
METHODS
The study population consisted of critically ill patients who were projected to require intragastric tube feeding for more than 7 days. The patients were prospectively assigned to one of two treatment groups and were randomized to receive either Rikkunshito (2.5 g) or metoclopramide (10 mg) every 8 h. All patients received standard enteral nutrition. Patients in both groups were begun on intragastric tube feeding according to our institution's feeding protocol.
RESULTS
All patients were undergoing mechanical ventilation at the time of enrollment. The portions of enteral nutrition provided to the target amount and the quantity of gastric discharge were not statistically significantly different between the two groups. The Rikkunshito group reached 50% of the target amount of enteral feeding significantly earlier than the metoclopramide group, although the proportion of patients in whom enteral feeding was successful did not differ significantly between the two groups. Patients in the Rikkunshito group showed significantly higher plasma levels of active ghrelin compared to those in the metoclopramide group.
CONCLUSIONS
The administration of Rikkunshito increased the plasma level of active ghrelin, and induced prokinetic effects that were greater than those observed following treatment with metoclopramide in critically ill patients.
TRIAL REGISTRATION
UMIN00000356.
背景
和胃汤是一种传统的日本药物，已广泛用于治疗各种胃肠道症状的患者。最近，和胃汤对各种疾病患者的促动力作用在日本引起了关注。和胃汤的促动力作用被认为是由于活性胃饥饿素的增加，胃饥饿素在胃中含量最丰富，具有胃肠动力功能。本初步研究的目的是研究和胃汤对危重症患者胃内肠内喂养和血浆胃饥饿素水平的影响。
方法
研究人群包括预计需要胃内管饲喂养超过 7 天的危重症患者。患者前瞻性地分为两组，并随机接受和胃汤（2.5g）或甲氧氯普胺（10mg）每 8 小时一次。所有患者均接受标准肠内营养。两组患者均按照我院的喂养方案开始进行胃内管饲喂养。
结果
所有患者在入组时均接受机械通气。两组患者提供的肠内营养量与目标量以及胃排出量均无统计学差异。和胃汤组达到 50%的目标肠内喂养量的时间明显早于甲氧氯普胺组，尽管两组患者中成功进行肠内喂养的比例无显著差异。和胃汤组患者的血浆活性胃饥饿素水平明显高于甲氧氯普胺组。
结论
和胃汤可增加血浆中活性胃饥饿素水平，并诱导出比甲氧氯普胺更强的促动力作用，在危重症患者中。
试验注册号
UMIN00000356。
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