红霉素联合甲氧氯普胺治疗重症监护病房机械通气患者胃排空障碍

Erythromycin combined with metoclopramide in feeding intolerance of mechanically ventilated patients in intensive care unit

目的比较红霉素、甲氧氯普胺以及红霉素联合甲氧氯普胺治疗重症监护病房(ICU)机械通气患者胃排空障碍的作用,筛选出影响红霉素、甲氧氯普胺起作用的独立相关因素。方法 2007年1月至2009年12月227例进行有创机械通气和需要早期肠内营养支持>5 d的患者,分为3组:红霉素组(73例,200 mg,iv,gtt,q12 h),甲氧氯普胺组(78例,10 mg,iv,q8 h),红霉素(200 mg,iv,gtt,q12 h)联合甲氧氯普胺(10 mg,iv,q8 h)治疗组(76例)。各组第1次给药在入ICU 24 h后第1个08:00,共5 d。记录每日胃液潴留量以及患者基本情况。比较每日的胃液潴留量以及每日肠内营养喂养成功率。结果 (1)联合治疗组每日胃液潴留量最少,红霉素组次之,甲氧氯普胺组最多(P<0.05)。(2)联合治疗组的喂养成功率最高,其次为红霉素组,甲氧氯普胺组最差(P<0.05)。(3)肠内营养前24 h的胃液潴留量、高血糖水平、缩血管药的使用明显影响红霉素或甲氧氯普胺的促进肠道动力作用。结论小剂量红霉素联合甲氧氯普胺治疗ICU机械通气患者胃排空障碍效果显著。肠内营养前24 h的胃液潴留量、高血糖水平、缩血管药的使用为影响肠道动力药作用的独立相关因素。

AIM To investigate the effect of erythromycin combined with metoclopramide and associated factors on feed intolerance of mechanically ventilated critically ill patients in ICU.METHODS Two hundred and twenty-seven patients met criteria were included in the study from January 2007 to December 2009,and the patients required mechanical ventilation and received early enteral nutrition at least 5 days.Patients were randomized into erythromycin group（n = 73,200 mg,iv,gtt,q12 h）,metoclopramide group（n = 78,10 mg,iv,q8 h） and combination therapy group（n = 76,erythromycin 200 mg,iv,gtt,q12 h and metoclopramide 10 mg,iv,q8 h）.The administration was taken first at 8 am after 24 hours ICU admission and for 5 days.Residual gastric volume was aspirated and measured every day.The general condition of patients was also recorded.The everyday gastric residual volume and the effectiveness of enteral feeding were compared.RESULTS（1） The everyday gastric residual volume in the combination therapy group was lower than the other groups,and that in the metoclopramide group was greater than the other groups（P 0.05）.（2） The successful rate of feeding in the combination therapy group was the highest,and that in the metoclopramide group was the lowest（P 0.05）.（3） Pretreatment 24-hour gastric residual volume,high blood sugar and requirement for inotropic drug support were the factors that significantly affected the prokinetic effect of erythromycin or metoclopramide.CONCLUSION Low dose erythromycin combined with metoclopramide could greatly improve feeding intolerance in mechanically ventilated patients.Factors associated with a poor response to prokinetic therapy are pretreatment 24-hour gastric residual volume,high blood sugar and requirement for inotropic drug support.