Cisapride improves gastric emptying in mechanically ventilated, critically ill patients - A randomized, double-blind trial
Cisapride improves gastric emptying in mechanically ventilated, critically ill patients - A randomized, double-blind trial
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DOI：
10.1164/ajrccm.154.6.8970354
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发表时间：
1996-12-01
影响因子：
24.7
通讯作者：
Guyatt, GH
中科院分区：
文献类型：
--
作者：
Heyland, DK;Tougas, G;Guyatt, GH
我们在机械通气的重症监护病房（ICU）患者中进行了一项随机、双盲、安慰剂对照试验，使用对乙酰氨基酚吸收模型评价西沙必利对胃排空的影响。我们入组了72例预计在ICU停留超过48小时的患者; 39%为女性;平均年龄为54.0 ± 19.1岁; 47%为术后患者，83%接受麻醉剂治疗，平均简化急性生理评分（SAPS）为9.5 ± 3.0。在入住ICU后72小时内，通过鼻胃管向胃内给予1.6 g对乙酰氨基酚混悬液（第1天）。在基线、30、60、90、120和180分钟时抽取血液样本，用于测量血浆对乙酰氨基酚水平。第二天早晨（第2天），患者随机接受20 mg西沙必利或安慰剂，并再次评估胃排空。西沙必利组最大血药浓度的差异（第2天-第1天）为49.1 μ mol/L，安慰剂组为12.3 μ mol/L（p = 0.005），西沙必利组达到最大血药浓度的时间显著较短（-40.8 min vs-4.2 min，p = 0.02）。西沙必利组患者的时间-对乙酰氨基酚浓度曲线下面积差异也较大（5,534 vs 2,832，p = 0.09）。我们得出结论，西沙必利增强胃排空危重病人。研究西沙必利对肠内营养耐受性、感染发病率和其他临床重要结局的影响是必要的。
We conducted a randomized, double-blind, placebo-controlled trial in mechanically ventilated intensive care unit (ICU) patients to evaluate the effect of cisapride on gastric emptying using an acetaminophen absorption model. We enrolled 72 patients expected to remain in the ICU for more than 48 h; 39% were female; the average age was 54.0 +/- 19.1 yr; 47% were postoperative, 83% were receiving narcotics, and the mean simplified acute physiology score (SAPS) was 9.5 +/- 3.0. Within 72 h of admission to ICU, 1.6 g of acetaminophen suspension was administered via a nasogastric tube into the stomach (Day 1). Blood samples were drawn at baseline, 30, 60, 90, 120, and 180 min for measurement of plasma acetaminophen levels, The following morning (Day 2), patients were randomized to receive 20 mg of cisapride or placebo and gastric emptying was again assessed. The difference (Day 2 - Day 1) in the maximal plasma concentration was 49.1 mu mol/L in the cisapride groups compared with 12.3 mu mol/L in the placebo group (p = 0.005) and the time to reach maximal concentration was significantly shorter in the cisapride group (-40.8 min versus -4.2 min, p = 0.02). The difference in area under the time-acetaminophen concentration curve was also greater in the patients receiving cisapride (5,534 versus 2,832, p = 0.09). We conclude that cisapride enhances gastric emptying in critically ill patients. Studies to examine the effect of cisapride on tolerance to enteral nutrition, infectious morbidity, and other clinically important outcomes are warranted.