预防性应用促胃肠动力药对重型颅脑损伤患者喂养不耐受发生的影响  

Effect of prophylactic application of prokinetic drugs on feeding intolerance following severe traumatic brain injuries

作　　者：房玉丽 何海燕 张晶 彭晓玉 朱京慈 Fang Yuli;He Haiyan;Zhang Jing;Peng Xiaoyu;Zhu Jingci(Department of Nursing,General Hospital of Northern Theater Command,Shenyang 100011,China;Nursing Department,Daping Hospital,Army Medical University,Chongqing 400042,China;Critical Care Unit,Daping Hospital,Army Medical University,Chongqing 400042,China;School of Nursing,Army Medical University,Chongqing 400038,China)

机构地区：[1]北部战区总医院护理部,沈阳100011 [2]陆军军医大学大坪医院护理部,重庆400042 [3]陆军军医大学大坪医院重症监护病房,重庆400042 [4]陆军军医大学护理系,重庆400038

出　　处：《创伤外科杂志》2022年第12期902-907,共6页Journal of Traumatic Surgery

摘　　要：目的探讨预防性应用促胃肠动力药对重型颅脑损伤(severe traumatic brain injury,sTBI)患者肠内营养喂养不耐受(feeding intolerance,FI)发生的影响。方法回顾性分析2013年3月—2019年3月陆军军医大学大坪医院ICU收治的117例sTBI患者,男性85例,女性32例;年龄32~62岁,平均49.0岁。根据是否预防性应用促胃肠动力药,分为预防组1(43例)和对照组1(74例),预防组1在未出现喂养不耐受表现时用促胃肠动力药,对照组1未用促胃肠动力药。将患者基线数据及观察期主要影响胃肠功能的治疗措施(脱水剂、抑酸剂、灌肠剂、镇痛剂)行1∶1的倾向性评分匹配后,分为预防组2和对照组2,各40例。比较两组患者便秘、腹泻等FI相关症状发生情况。结果预防性应用促胃肠动力药可以降低sTBI患者FI发生率[38%vs.62%,P=0.025],减少便秘的发生[10%vs.27%,P=0.045],促进自主排便的恢复[1.0(0.0,4.0)vs.0.0(0.0,2.0),P=0.025],同时未增加腹泻发生率[13%vs.10%,P=1.000]。胃潴留、腹胀、呕吐及合并两种及以上症状发生率组间比较差异无统计学意义(P>0.05)。结论预防性应用促胃肠动力药能显著降低sTBI患者便秘的发生,促进自主排便的恢复,但对其他胃肠症状改善作用不明显。Objective To investigate the effect of prophylactic application of prokinetic drugs on feeding intolerance(FI)during enteral nutrition following severe traumatic brain injuries(sTBI).Methods From Mar.2013 to Mar.2019,117 patients with sTBI admitted to the ICU in Daping Hospital of Army Medical University were analyzed retrospectively.There were 85 males and 32 females.The average age was 49.0 years,range 32-62 years.According to whether prophylactic use of prokinetic drugs was conducted or not,patients were divided into prevention group 1(n=43)and control group 1(n=74).Thereafter the baseline data of the patients and the treatment strategies(dehydrating agent,acid inhibitor,enema,and analgesics)which mainly affect the gastrointestinal function during the observation period were scored and matched at 1∶1,which finally included 40 cases each in the prevention group 2 and control group 2.FI-related symptoms such as constipation and diarrhea were compared between the two groups.Results Prophylactic use of prokinetic drugs can reduce the incidence of FI in patients following sTBI(38%vs.62%,P=0.025),decrease the incidence of constipation(10%vs.27%,P=0.045),and promote the recovery of spontaneous defecation[1.0(0.0,4.0)vs.0.0(0.0,2.0),P=0.025]without increasing the incidence of diarrhea[prevention group 13%vs.control group 10%,P=1.000].There was no significant difference in the incidence of gastric retention,abdominal distension,vomiting or combined with two or more symptoms between the two groups(P>0.05).Conclusion Prophylactic application of prokinetic drugs can significantly reduce the incidence of constipation in patients following sTBI,but the effect on the improvement of other gastrointestinal symptoms remains to be determined.

关 键 词：重型颅脑损伤 喂养不耐受 促胃肠动力药 

分 类 号：R651.15[医药卫生—外科学]