Seyam Sameh Hamdy Abdelhamid, Elabd Hassan Ibrahim, Elabd Hassan Abdallah, Mohamad Elsayed Mostafa
Anesthesiology, Intensive Care and Pain Management Department, Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt.
Anesthesiology, Intensive Care and Pain Management Department, Faculty of Medicine, Aswan University, Aswan, Egypt.
Anesth Pain Med. 2025 Feb 17;15(1):e158019. doi: 10.5812/aapm-158019. eCollection 2025 Feb 28.
Delayed gastric emptying increases the risk of patient morbidity in the ICU. Intensive care researchers have exerted considerable effort to measure and regulate gastric residual volumes (GRV) in ventilator-operated patients.
This study examines a cross-sectional, double-blind clinical trial designed to assess the effect of the addition of neostigmine to metoclopramide GRV in ICU patients and the risk of aspiration in those patients.
Participants were categorized into three groups: Group I (n = 41) and group II (n = 43) received neostigmine 1 mg and 2 mg, respectively, and a control group (group III, n = 40) received 10 mL of normal saline. All participants received an intravenous administration of 10 mg of metoclopramide. The GRV was measured every 3 hours before enteral feeding. Aspiration through nasogastric (NG) or orogastric (OG) tubes was done before the next due bolus of feeding. The study did not receive any external funding support. The possessed data was interpreted using the PASS program, which set the alpha error at 5% and the power at 80%.
There was a significant variation among the three groups regarding the GRV. Metoclopramide used alone, did not profoundly alter the GRV at various time intervals. However, the administration of neostigmine resulted in a significant reduction in GRV at 3 and 6 hours post-injection. The GRV increased six hours post-injection, indicating that the drug combination resulted in a short-term effect. We did not observe any significant link between GRV and aspiration incidence, which happened even with low-volume aspirations. We used immunoassay to determine pepsin in the collected tracheal aspirations.
Combining neostigmine and metoclopramide can effectively reduce GRV in ICU patients receiving enteral nutrition.
胃排空延迟会增加重症监护病房（ICU）患者发病的风险。重症监护研究人员已付出相当大的努力来测量和调节使用呼吸机患者的胃残余量（GRV）。
本研究考察一项横断面双盲临床试验，旨在评估在ICU患者中加用新斯的明对甲氧氯普胺GRV的影响以及这些患者发生误吸的风险。
参与者被分为三组：第一组（n = 41）和第二组（n = 43）分别接受1 mg和2 mg新斯的明，对照组（第三组，n = 40）接受10 mL生理盐水。所有参与者均静脉注射10 mg甲氧氯普胺。在肠内喂养前每3小时测量一次GRV。在下一次预定推注喂养前通过鼻胃管（NG）或口胃管（OG）进行误吸情况检查。该研究未接受任何外部资金支持。使用PASS程序对所收集的数据进行解读，设定α错误为5%，检验效能为80%。
三组之间的GRV存在显著差异。单独使用甲氧氯普胺在不同时间间隔并未显著改变GRV。然而，注射新斯的明后3小时和6小时GRV显著降低。注射6小时后GRV升高，表明联合用药产生了短期效应。我们未观察到GRV与误吸发生率之间存在任何显著关联，即使是少量误吸情况也会发生。我们使用免疫测定法测定收集的气管吸出物中的胃蛋白酶。
新斯的明与甲氧氯普胺联合使用可有效降低接受肠内营养的ICU患者的GRV。
