Effects of combined prokinetic administration on gastric emptying in critically ill patients
Effects of combined prokinetic administration on gastric emptying in critically ill patients
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DOI：
10.1016/j.ajg.2017.01.007
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发表时间：
2017-03-01
影响因子：
1.4
通讯作者：
Sahebkar, Amirhossein
中科院分区：
文献类型：
--
作者：
Baradari, Afshin Gholipour;Khajavi, Mohammad Reza;Sahebkar, Amirhossein
背景和研究目的：当单一药物不能改善喂养不耐受时，经常使用具有不同作用机制的促动力药物的组合。在这项研究中，我们评估了新斯的明和胃复安联合输注对重症监护室（ICU）危重患者胃通道的影响。患者和方法：这项研究是一项随机双盲对照试验，90例年龄在20至60岁之间的患者接受机械通气，最后一次灌洗后3小时胃残留量（GRV）> 120 mL。患者被随机分配到以下三组中的一组：静脉注射新斯的明2.5 mg，静脉注射甲氧氯普胺20 mg，以及上述剂量的两种药物的组合。在研究开始前首先进行胃容量抽吸，然后在研究药物输注结束后3、6、9和12 h进行。洗胃量增加定义为抽吸量> 120 mL。结果：三组中共有86例完成治疗（根据意向治疗方法对研究中纳入的所有90例患者进行分析）。在基线时，研究组之间在年龄、插管持续时间、白蛋白、血红蛋白、红细胞压积、总白细胞计数（WBC）、Na、K、Mg和序贯器官衰竭评估评分方面未检测到显著差异。在联合用药组中，96.7%的患者显示GRV改善（GRV < 120 cc），而在甲氧氯普胺和新斯的明组中，分别有50%和43.3%的患者显示改善（p < 0.001）。甲氧氯普胺、新斯的明和联合用药组的总体不良反应发生率分别为3.3%、16.7%和10%（p = 0.28）。结论：目前的结果表明，甲氧氯普胺和新斯的明联合治疗可降低危重患者的GRV，其疗效高于单药治疗。(C)2017泛阿拉伯胃肠病学协会。Elsevier B.V.出版，保留所有权利。
Background and study aims: Combination of prokinetic drugs with different mechanisms of action is frequently used when feeding intolerance is not improved with a single agent. In this study, we evaluated the effect of combined infusion of neostigmine and metoclopramide on gastric passage in critically ill patients in the intensive care unit (ICU).Patients and methods: This study is a randomized double-blind controlled trial in 90 patients between 20 and 60 years of age who were under mechanical ventilation and had gastric residual volumes (GRVs) > 120 mL 3 h after the last lavage. Patients were randomly assigned to one of the following three groups: intravenous neostigmine 2.5 mg, intravenous metoclopramide 20 mg, and combination of both agents at the mentioned doses. Gastric volume aspiration was first performed before starting the study and then at 3, 6, 9, and 12 h after the infusion of study drugs was finished. Increase in gastric lavage was defined as an aspiration volume of > 120 mL.Results: In total, 86 cases in the three groups completed the treatment (all 90 patients included in the study were analysed according to an intention-to-treat approach). There was no significant difference detected at baseline in age, intubation duration, albumin, haemoglobin, haematocrit, total leucocytic count (WBC), Na, K, Mg, and sequential organ failure assessment score between the study groups. In the combination group, 96.7% of patients showed GRV improvement (GRV < 120 cc), whereas in the metoclopramide and neostigmine groups, 50% and 43.3% of the patients, respectively, showed improvement (p < 0.001). The frequency of overall adverse effects in the metoclopramide, neostigmine, and combination groups were 3.3%, 16.7%, and 10%, respectively (p = 0.28).Conclusions: The present results suggested that combination therapy with metoclopramide and neostigmine decreases GRV in critically ill patients with a higher efficacy than monotherapies. (C) 2017 Pan-Arab Association of Gastroenterology. Published by Elsevier B.V. All rights reserved.