Whatley K, Turner W W, Dey M, Leonard J, Guthrie M
JPEN J Parenter Enteral Nutr. 1984 Nov-Dec;8(6):679-81. doi: 10.1177/0148607184008006679.
Postpyloric feeding probably reduces the incidence of tracheobronchial aspiration and improves feeding tolerance. However, duodenal intubation is often unsuccessful in critically ill patients due to gastric atony. Metoclopramide improves gastric emptying. In a pilot study, 12 adult patients were administered 10 to 20 mg of intravenous metoclopramide after weighted nasal feeding tubes had failed to spontaneously pass distal to the pylorus. In no patient did metoclopramide induce transpyloric passage of the tube. A randomized prospective study involving 10 adult patients was conducted to examine the effect of preinsertion intravenous metoclopramide on transpyloric intubation. All patients had failed to achieve spontaneous duodenal intubation. Five patients received 20 mg of metoclopramide 10 min prior to nasal insertion of a weighed feeding tube. Five control patients received no premedication. Four metoclopramide patients achieved duodenal intubation immediately. In none of the control patients did transpyloric intubation occur (p = 0.048). Metoclopramide, administered after nasogastric intubation, is ineffective in promoting transpyloric advancement of feeding tubes. There is a significant increase in transpyloric intubation when metoclopramide is administered prior to tube insertion.
幽门后喂养可能会降低气管支气管误吸的发生率并提高喂养耐受性。然而，由于胃无力，十二指肠插管在重症患者中常常不成功。甲氧氯普胺可改善胃排空。在一项初步研究中，12名成年患者在加重的鼻饲管未能自发通过幽门远端后，静脉注射了10至20毫克甲氧氯普胺。没有一名患者的鼻饲管因甲氧氯普胺而通过幽门。进行了一项涉及10名成年患者的随机前瞻性研究，以检查插管前静脉注射甲氧氯普胺对经幽门插管的影响。所有患者均未能实现自发十二指肠插管。5名患者在插入加重鼻饲管前10分钟接受了20毫克甲氧氯普胺。5名对照患者未接受预处理。4名接受甲氧氯普胺治疗的患者立即实现了十二指肠插管。对照患者中无一例发生经幽门插管（p = 0.048）。鼻胃插管后给予甲氧氯普胺对促进饲管经幽门推进无效。插管前给予甲氧氯普胺时，经幽门插管显著增加。
