纳络酮治疗重症患者胃排空障碍的临床研究

Clinical study of naloxone in treatment of gastro-intestinal dysfunction in critically ill patients

目的：观察大剂量纳络酮治疗重症患者胃排空障碍的临床疗效。方法：选取需要早期肠内营养支持的385例患者,其中因61例病情变化而被删除,将324例分为4组：甲氧氯普胺组76例（10 mg,静脉注射,q8h）;红霉素组83例（0.25g,静脉滴注,q12h）;甲氧氯普胺联合红霉素组（联合治疗组）84例（用法同上）;大剂量纳洛酮组81例（5 mg,静脉滴注,持续1 h,q8h）。4组患者均在入住ICU 24 h后的第一个8 am给药,记录每日胃液潴留量及胃肠喂养情况。结果：1第1~7天联合治疗组的胃液潴留量明显少于甲氧氯普胺组和红霉素组（P〈0.01,P〈0.05）,第3~7天大剂量纳洛酮组的胃液潴留量明显少于甲氧氯普胺组和红霉素组（P〈0.05,P〈0.01）,但与联合治疗组比较无显著差异（P〉0.05）;2联合治疗组喂养成功率在第3天以后明显高于甲氧氯普胺组和红霉素组（P〈0.01）,大剂量纳洛酮组喂养成功率在第4天以后明显高于甲氧氯普胺组和红霉素组（P均〈0.01）,但与联合治疗组比较无显著差异（P〉0.05）。结论：大剂量纳洛酮有较好的促胃肠动力作用,尽管其起效较慢,但作用持久、明显。

Objectve： To observe the clinical therapeutic effect of large dose naloxone in treatment of gastrointestinal dysfunction in critically ill patients. Methods： Three hundred and eighty-five patients who need early enteral nutrition support were involved in the study,of which 61 were deleted due to changes of patients condition,then 324 cases were divided into 4 groups： 76 cases in the group of metoclopramide（ 10 mg for intravenous injection,q8h）,83 in the group of erythromycin（ 0. 25 g for intravenous drip,q12h）,84 in the group of metoclopramide and erythromycin（ combination therapy group,method as above）,81 in the group of large dose naloxone（ 5 mg for intratvenous drip,q8h）. All patients received the treatment at 8am in the first 24 hours after checked-in ICU,and recorded daily gastric residual volume and the general condition of enteral nutrition. Results： ① At 1 - 7 day,Gastric residual volume of combination therapy group using metoclopramide and erythromycin was significantly less than that of metoclopramide group and erythromycin group（ P〈 0. 01,P 〈0. 05）.At 3 - 7 day,gastric residual volume of large dose naloxone group was less than that of metoclopramide group and erythromycin group（ P 〈0. 05,P 〈0. 01）,but there was no significant difference as comparing with combination therapy group（ P〉 0. 05）. ② Combination therapy group had higher rate of successful feeding after treating for 3 days than that of metoclopramide and erythromycin group（ P 〈0. 01）. After treating for 4 days,large dose naloxone group had obviously higher rate of successful feeding than metoclopramide and erythromycin（ P〈 0. 01）,but no significant difference was observed between large dose naloxone group and combination therapy group（ P〉 0. 05）. Conclusions： Large dose of naloxone is useful to promote gastrointestinal motility and regulate gastrointestinal function,although its efficacy emerges slowly,once it occurs,it is rather durable and obvious.