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目的 了解重症监护病房机械通气患者腹泻的原因、性质 ,探讨其处理对策和预防措施。方法 1998年 1月～ 1999年 12月呼吸监护室收住的 5 6例机械通气超过 48h ,上机前无腹泻 (稀便次数 >3次 /d[1] )的患者于机械通气当天开始行胃肠营养 ,分次从鼻胃管输注。胃肠泵控制速度在40～ 12 0ml/h ,营养素经加热后进入胃管。所有患者上机期间均使用静脉抗生素等药物。结果 机械通气后 ,有 33例 (5 9% )患者发生呼吸机相关肺炎 (VAP) ;19例 (34 % )患者发生过腹泻 ,腹泻平均持续13d。其中 8例患者大便涂片中找到多量真菌孢子 ,3例同时找到菌丝 ;4例大便中杆菌明显减少 ,以球菌为主 ,其中 3例患者大便中可见粪肠球菌 ;2例患者既有真菌又有球菌 /杆菌比失调 ;9例腹泻患者大便常规及菌群正常 ,仅 1例发现少量真菌孢子 ,经调整胃肠营养的温度及速度 ,腹泻在 1～ 2d内消失。采用Logistic检验发现 ,腹泻的发生与VAP有关。结论 在胃肠营养输注条件最优化后 ,合理应用抗生素 ,预防及积极治疗VAP ,可减少机械通气期间腹泻的发生并缩短腹泻的持续时间。
Objective To understand the causes and the nature of diarrhea in patients with mechanical ventilation in intensive care unit and to discuss its treatment strategies and preventive measures. Methods Fifty-six patients with mechanical ventilation admitted to Respiratory Care Unit from January 1998 to December 1999 were ventilated for more than 48 hours. Patients without diarrhea (loose stool> 3 times / d [1]) on the day of mechanical ventilation started Gastrointestinal nutrition, graded from the nasogastric tube infusion. Gastrointestinal pump control speed at 40 ~ 120ml / h, nutrients into the stomach after heating. All patients on the plane during the use of intravenous antibiotics and other drugs. Results Ventilator-associated pneumonia (VAP) occurred in 33 (59%) patients after mechanical ventilation; diarrhea occurred in 19 patients (34%) with an average duration of 13 days. Among them, a large number of fungal spores were found in stool smears of 8 patients and 3 mycelia were found at the same time. Bacillus was mainly found in 4 cases of stool and mainly of cocci, of which 3 cases were found to be Enterococcus faecalis in feces; 2 cases were both fungal The ratio of cocci / bacilli was also out of control. The routine stools and normal flora in 9 cases of diarrhea were normal. Only a few cases of fungal spores were found. After adjusting the temperature and speed of gastrointestinal nutrition, diarrhea disappeared within 1-2 days. Using Logistic test found that the occurrence of diarrhea and VAP. Conclusions After the optimal gastrointestinal nutrition infusion conditions, rational use of antibiotics to prevent and actively treat VAP can reduce the incidence of diarrhea during mechanical ventilation and shorten the duration of diarrhea.