Bosscha K, Nieuwenhuijs V B, Vos A, Samsom M, Roelofs J M, Akkermans L M
Department of Surgery, University Hospital Utrecht, The Netherlands.
Crit Care Med. 1998 Sep;26(9):1510-7. doi: 10.1097/00003246-199809000-00017.
To determine the fasted and fed gastrointestinal motility characteristics that are possibly responsible for gastric retention in mechanically ventilated patients.
Prospective, case series.
Surgical intensive care unit of a university hospital.
Seven patients who required mechanical ventilation for thoracic or combined thoracic-neurologic injuries and nine healthy volunteers.
None.
Antroduodenal manometry was performed during fasting and gastric feeding with a polymeric diet in patients during mechanical ventilation, weaning, and after detubation. Gastric retention volumes were determined during gastric tube feeding. Motility data were compared with recordings from nine healthy volunteers. During the fasting state, under sedation and morphine, the migrating motor complex in patients was significantly (p < .001) shortened: median 32.0 vs. 101.0 mins in healthy volunteers. During gastric tube feeding, the motility pattern did not convert to a normal postprandial pattern until morphine was discontinued. An interdigestive or mixed interdigestive-postprandial pattern was seen during gastric tube feeding in most patients during morphine administration. Most (94%) of the activity fronts during gastric feeding started in the duodenum. Gastric retention percentages during gastric tube feeding were negatively correlated (r2=.44; p < .01) with antral motor activity.
These data suggest that morphine administration affects antroduodenal motility in mechanically ventilated patients. The gastrointestinal motor pattern involved in impaired gastric emptying in morphine-treated patients is characterized by antral hypomotility and persisting duodenal activity fronts during continuous intragastric feeding. The observed motility patterns suggest that early administration of enteral feeding might be more effective into the duodenum or jejunum than into the stomach of mechanically ventilated patients.
确定可能导致机械通气患者胃潴留的禁食和进食状态下的胃肠动力特征。
前瞻性病例系列研究。
大学医院的外科重症监护病房。
7例因胸外伤或胸-神经联合损伤需要机械通气的患者和9名健康志愿者。
无。
在机械通气、撤机和拔管期间，对患者进行禁食和经胃给予聚合饮食时的十二指肠测压。在胃管喂养期间测定胃潴留量。将动力数据与9名健康志愿者的记录进行比较。在禁食状态下，在使用镇静剂和吗啡的情况下，患者的移行性运动复合波明显缩短（p < 0.001）：健康志愿者的中位数为101.0分钟，而患者为32.0分钟。在胃管喂养期间，直到停用吗啡，动力模式才转变为正常的餐后模式。在给予吗啡期间，大多数患者在胃管喂养期间出现消化间期或消化间期与餐后混合的模式。胃喂养期间的大多数（94%）活动前沿始于十二指肠。胃管喂养期间的胃潴留百分比与胃窦运动活性呈负相关（r2 = 0.44；p < 0.01）。
这些数据表明，吗啡给药会影响机械通气患者的十二指肠动力。吗啡治疗患者胃排空受损所涉及的胃肠动力模式的特征是胃窦动力不足以及在持续胃内喂养期间十二指肠活动前沿持续存在。观察到的动力模式表明，对于机械通气患者，早期肠内喂养给予十二指肠或空肠可能比给予胃更有效。
