Gholipour Baradari Afshin, Alipour Abbas, Firouzian Abolfazl, Moarab Laleh, Emami Zeydi Amir
Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
Department of Epidemiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
Acta Inform Med. 2016 Dec;24(6):385-389. doi: 10.5455/aim.2016.24.385-389.
In critically ill patients, enteral feeding through the nasogastric tube is the method of choice for nutritional support. Gastrointestinal feeding intolerance and disturbed gastric emptying are common challenges in these patients. The aim of this study was to compare the effect of Neostigmine and Metoclopramide on gastric residual volume (GRV) in mechanically ventilated ICU patients.
In a double blind, randomized clinical trial, a total of 60 mechanically ventilated ICU patients with GRV >120 mL (3 hours after the last gavage), were randomly assigned into two groups A and B. At baseline and 6 hours later, patients in group A and B received intravenous infusion of neostigmine in a dose of 2.5 mg and metoclopramide in a dose of 10 mg in 100 ml of normal saline, within 30 minutes. Patients' gastric residual volumes were evaluated before the beginning of the intervention, and 3, 6, 9 and 12 hours after the intervention.
After adjusting of other variables (Sex, BMI and ICU stay period) generalized estimating equation (GEE) model revealed that neostigmine treatment increased odds of GRV improvement compare to metoclopramide group (Estimate 1.291, OR= 0.3.64, 95% CI 1.07-12.34). However there is a statistically significant time trend (within-subject differences or time effect) regardless of treatment groups (P<0.001). The median time from intervention to GRV improvement was 6 hours (95% CI 3.75-8.25) and 9 hours (95% CI 7.38-10.17) in neostigmine and metoclopramide groups, respectively. This difference was statistically significant (P<0.05).
It seems that neostigmine is more effective than metoclopramide in reducing GRV and improving gastric emptying in mechanically ventilated ICU patients without significant complication and this protocol may be effective on the tolerance of enteral feeding in ICU patients. Further well-designed randomized clinical trials are needed.
在重症患者中，经鼻胃管进行肠内喂养是营养支持的首选方法。胃肠道喂养不耐受和胃排空障碍是这些患者常见的挑战。本研究的目的是比较新斯的明和甲氧氯普胺对机械通气的重症监护病房（ICU）患者胃残余量（GRV）的影响。
在一项双盲、随机临床试验中，共有60例机械通气的ICU患者，其胃残余量>120 mL（最后一次管饲后3小时），被随机分为A组和B组。在基线时和6小时后，A组和B组患者在30分钟内接受静脉输注2.5 mg新斯的明和10 mg甲氧氯普胺，溶于100 ml生理盐水中。在干预开始前以及干预后3、6、9和12小时评估患者的胃残余量。
在调整其他变量（性别、体重指数和ICU住院时间）后，广义估计方程（GEE）模型显示，与甲氧氯普胺组相比，新斯的明治疗增加了胃残余量改善的几率（估计值1.291，OR = 0.364，95%置信区间为1.07 - 12.34）。然而无论治疗组如何，都存在统计学上显著的时间趋势（受试者内差异或时间效应）（P<0.001）。新斯的明组和甲氧氯普胺组从干预到胃残余量改善的中位时间分别为6小时（95%置信区间3.75 - 8.25）和9小时（95%置信区间7.38 - 10.17）。这种差异具有统计学意义（P<0.05）。
在机械通气的ICU患者中，新斯的明在降低胃残余量和改善胃排空方面似乎比甲氧氯普胺更有效，且无明显并发症，该方案可能对ICU患者的肠内喂养耐受性有效。需要进一步设计良好的随机临床试验。
