肠梗阻是成人手术患者的常见挑战,估计发病率为17%至80%。术后肠梗阻病理生理学的主要机制是液体超负荷,外源性阿片类药物,神经激素功能障碍,胃肠伸展,和炎症。管理包括解决根本原因和支持性护理。已经提出了多种医疗干预措施,但有效性是不确定的。东方创伤外科协会的一个工作组旨在评估甲氧氯普胺的有效性,红霉素,和早期肠内营养(EEN)治疗成人手术患者肠梗阻,并制定适用于日常临床实践的建议。
文献检索确定了45篇适合纳入的文章。建议评估的分级,开发和评价方法用于评价甲氧氯普胺的效果,红霉素,和EEN基于选定的结果对成人手术患者肠梗阻的解决:正常肠功能的恢复,实现肠内喂养目标,和住院时间。这些建议是根据系统审查的结果提出的,荟萃分析,和评估证据水平。
所有PICOs的证据水平被评估为较低。甲氧氯普胺和红霉素均未有效加速肠梗阻的解决。对32项随机对照试验的分析表明,EEN有助于肠功能恢复正常。实现肠内营养目标,减少住院时间。
在接受过腹部手术的患者中,我们强烈建议EEN加快肠梗阻的解决,但我们不建议使用甲氧氯普胺或红霉素来加速这些患者肠梗阻的消退.
研究类型治疗,二级。
Ileus is a common challenge in adult surgical patients with estimated incidence to be 17% to 80%. The main mechanisms of the postoperative ileus pathophysiology are fluid overload, exogenous opioids, neurohormonal dysfunction, gastrointestinal stretch, and inflammation. Management includes addressing the underlying cause and supportive care. Multiple medical interventions have been proposed, but effectiveness is uncertain. A working group of the Eastern Association for the Surgery of Trauma aimed to evaluate the effectiveness of metoclopramide, erythromycin, and early enteral nutrition (EEN) on ileus in adult surgical patients and to develop recommendations applicable in a daily clinical practice.
Literature search identified 45 articles appropriate for inclusion. The Grading of Recommendations Assessment, Development and Evaluation methodology was applied to evaluate the effect of metoclopramide, erythromycin, and EEN on the resolution of ileus in adult surgical patients based on selected outcomes: return of normal bowel function, attainment of enteral feeding goal, and hospital length of stay. The recommendations were made based on the results of a systematic review, a meta-analysis, and evaluation of levels of evidence.
The level of evidence for all PICOs was assessed as low. Neither metoclopramide nor erythromycin were effective in expediting the resolution of ileus. Analyses of 32 randomized controlled trials showed that EEN facilitates return of normal bowel function, achieving enteral nutrition goals, and reducing hospital length of stay.
In patients who have undergone abdominal surgery, we strongly recommend EEN to expedite resolution of Ileus, but we cannot recommend for or against the use of either metoclopramide or erythromycin to hasten the resolution of ileus in these patients.
Type of Study Therapeutic, level II.