红霉素和甲氧氯普胺治疗重症监护病房患者胃排空障碍的研究

Study of erythromycin and metoclopramide in treatment of feeding intolerance of critically ill patients in intensive care unit

目的观察红霉素、甲氧氯普胺单用或联用治疗重症监护病房（ICU）患者胃排空障碍的作用。方法收集2007年1月至2009年1月在ICU需要早期肠内营养支持〉7d的患者152例，并按随机数字表法分为红霉素组（200mg静脉滴注，12h1次）、甲氧氯普胺组（10mg静脉注射，8h1次）及红霉素和甲氧氯普胺联用组，共给药7d。记录基本情况以及每日03：00、09：00、15：00和21：00患者的胃液潴留量；比较各组每日胃液潴留量及肠内营养喂养成功率的变化；并筛选影响红霉素和甲氧氯普胺起作用的独立相关因素。结果联合治疗组每日胃液潴留量最少[最高达（40±8）m13，红霉素组次之[最高达（42±7）m13，甲氧氯普胺组最多[最高达（59±8）ml，P〈0．05或P〈0．013。联合治疗组的喂养成功率最高（最高达97．4％），其次为红霉素组（最高达90．0％），甲氧氯普胺组最低（最高达89．5％，P〈0．05或P〈0．01）。肠内营养前24h的胃液潴留量（r=-0．584，P=0．000）、高血糖水平（r=-0．345，P=0．029）、高急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分（r=-0．437，P=0．005）、血管收缩药物使用（e=-0．389，P=0．041）为影响肠道动力药物起作用的独立相关因素。结论小剂量红霉素能提高ICU患者肠内营养喂养成功率；而且红霉素加甲氧氯普胺联合治疗胃排空障碍效果最佳，且不良反应小。

Objective To compare the effect of erythromycin and metoclopramide on feeding intolerance of critically ill patients in intensive care unit （ICU）. Methods One hundred and fifty-two critically ill patients in ICU who needed early enteral nutrition exceeding 7 days between January 2007 and January 2009 were included in the study. The patients were randomly divided into three groups., erythromycin group （200 mg intravenous drip, once every 12 hours）, metoclopramide group （10 mg intravenous injection, once every 8 hours）, and combination therapy group. The whole experiment was carried out for 7 days. Residual gastric volume was aspirated and measured every day at 03：00, 09：00, 15：00 and 21：0. The daily mean gastric residual volume was compared. At the same time, the daily effectiveness of erythromycin and metoclopramide on the success of feeding was also compared. The factors associated with a poor response to prokinetic therapy were looked for. Results The daily gastric residual volume in the combination therapy group was smallest, the maximum was （40±8） ml;the maximum of gastric residual volume in erythromycin group was （42±7） ml; the maximum of gastric residual volume in metoclopramide group was （59 ± 8） ml （P〈. 05 or P〈0. 01）. The successful rate of feeding was highest in the combination therapy group, and it was as high as 97.4%, the erythromycin group ranked the second （90. 0%）, and that of the metoclopramide group was lowest （89. 5%, P〈0. 05 or P〈0.01）. Factors that were associated with a poor response to prokinetic therapy was high pretreatment 24-hour gastric residual volume （r= -0. 584, P= 0. 000）, high blood sugar level （r=- 0. 345, P= 0. 029）, a high acute physiology and chronic health evaluation （APACHE Ⅱ ） score （r=-0. 437, P=0. 005）, and requirement for inotropic drug support （r=-0. 389, P=0. 041）. Conclusion Low dose of erythromycin could improve the successful rate of feeding in critically ill patients in ICU. The combined administration of erythromycin and metoclopramide was more effective. Its side effect was minimal.