Liang Yan, Xu Feiyi, Zhang Hao, Li Jiang, Chen Wei, Yang Qilin, Lin Cheng, Dong Xiaomin
The First Affiliated Hospital Of Guilin Medical University, No. 15, Lequn Road, Xiufeng District, Guilin, Guangxi Province, China.
Guilin Medical University, No. 1 Zhiyuan Road, Lingui District, Guilin, Guangxi, China.
J Intensive Care. 2025 May 21;13(1):27. doi: 10.1186/s40560-025-00797-9.
This study investigates the impact of four laxatives-Senna, Docusate Sodium, Polyethylene Glycol, and Lactulose on 28-day mortality, ICU-free days, ventilator-free days, bowel recovery, and Clostridium difficile (C-diff) infection in critically ill sepsis patients to identify optimal bowel management strategies for improving survival and recovery.
Using the MIMIC-IV database (v3.1), we analyzed 7163 ICU sepsis patients (median age: 67.5 years; 63% male), assessing 28-day mortality, ICU-free days, vasopressor-free days, ventilator-free days, bowel sound recovery, and C-diff incidence, with propensity score matching and multivariable adjustments for confounders, alongside subgroup analyses by sex, age, Charlson Comorbidity Index, and Sequential Organ Failure Assessment score.
Docusate Sodium was associated with significantly lower 28-day mortality (adjusted HR: 0.43; 95% CI 0.36-0.52), more ICU-free days, and better bowel recovery compared to Senna, while Lactulose was linked to higher mortality (adjusted HR: 1.82; 95% CI 1.45-2.27), fewer ICU-free days, and increased C. difficile risk, with subgroup analyses confirming these trends across sex, age, and comorbidity strata.
Docusate sodium appears to be a safer and more effective bowel management option for critically ill patients with sepsis. In contrast, the association between lactulose use and adverse outcomes may primarily reflect the severity of underlying liver disease rather than a direct drug effect. These findings underscore the importance of individualized laxative selection based on patients' clinical context in critical care practice.
本研究调查了四种泻药——番泻叶、多库酯钠、聚乙二醇和乳果糖对重症脓毒症患者28天死亡率、无ICU天数、无呼吸机天数、肠道恢复情况以及艰难梭菌（C-diff）感染的影响，以确定改善生存和恢复的最佳肠道管理策略。
利用MIMIC-IV数据库（v3.1），我们分析了7163例ICU脓毒症患者（中位年龄：67.5岁；63%为男性），评估了28天死亡率、无ICU天数、无血管活性药物天数、无呼吸机天数、肠鸣音恢复情况以及C-diff发病率，并进行倾向得分匹配和对混杂因素的多变量调整，同时按性别、年龄、Charlson合并症指数和序贯器官衰竭评估评分进行亚组分析。
与番泻叶相比，多库酯钠与显著更低的28天死亡率（调整后HR：0.43；95%CI 0.36 - 0.52）、更多的无ICU天数以及更好的肠道恢复相关，而乳果糖与更高的死亡率（调整后HR：1.82；95%CI 1.45 - 2.27）、更少的无ICU天数以及增加的艰难梭菌风险相关，亚组分析在性别、年龄和合并症各层均证实了这些趋势。
对于重症脓脓毒症 脓毒症患者，多库酯钠似乎是一种更安全、更有效的肠道管理选择。相比之下，使用乳果糖与不良结局之间的关联可能主要反映了潜在肝病的严重程度，而非直接的药物效应。这些发现强调了在重症监护实践中根据患者临床情况进行个体化泻药选择的重要性。
