| Gastroenterology Medical College of Zhejiang University Postgraduate Xin Ying Tutor Director Dai NingBackgroundGastroesophageal reflux (GER) and duodenogastroesophageal reflux'(DGER) is very common in critically ill patients. It may lead to esophagitis,ulcer,upper GI bleeding, bronchospasm, asthma and aspiration pneumonia, which futher prolong the days of hospitalization and increase the motality. The possible pathogenesis includes the followings: Ohypovelemia, which could decrease the low esophageal pressure; 2)the central inhibition which is especially common in head-injured patients; 3)delayed gastric emptying,which decreases the gastroduodenal barrier pressue and increase the incidence of transient low esophageal relaxation; 4)drugs; 5)others such as position and mechanical ventilation .So many factors can be involved in the occurrence of GER and DGER.Studies in the Western have showed that in critically ill patients receiving mechanical ventilation ,the severity of esophagitis was relavent to gastric residual volume and there was positive correlation between DGER and the number of failure organs. But no relationship was showed between reflux parameters and PEEP, APACHE II. Study also showed that H2 receptor inhibitor could improve GER but no effect on DGER , and it may increase the incidence of ventilation-associated pneumonia.Due to the instrumental limitations the study of this field just started abroad and was carried out only in relatively stable patients domestically. Considering many confounding factors, how to purify the intervention factor in the study of gastroenteral kinetics in critically ill patients? What about the incidence of GER, DGER and the related factors in domestic critically ill patients? What' s theeffect of it receptor inhibitor on GER and DGER and whether it would increase the incidence of ventilation-associated pneumonia?To answering these questions our study included the following parts: observing the incidence of GER and DGER in critically ill patients; investigating the effect of fomotidine on GER and DGER and the incidence of ventilation associated pneumonia after administration; exploring the relationship between reflux and gastric residual volume, PEEP, MODS and APACHE II.1. Materials and method 1. 1 General conditions:From June of 2001 to February of 2002, nineteen critically ill patients were prospectively recruited in our study. They are ten males and nine females, with their age ranging from thirty to seventy years old and fifty-six point five on average. Patients were eligible if they had been fast for at least 6 hours, if they would receive mechnical ventilator support for more than two days, if they didn' t receive enteral nutrition though nasogastric tube before, if their serum bilirubin level was less than 2.Omg/dl, and if their therapeutic regimen didn' t change too much during the study. The exclusion criteria included active gastroenteral bleeding,presence of esophageal and fundic varices, mechanical ileus, previous thoracic or abdominal radiotherapy, esophageal or gastric surgery or cholecystectomy , previous GERD or gastroenteral dynamic disorders, esophageal or upper small intestinal Crohn' s disease, and patients receiving cisapride, erythromycin, atropine, theophylline, metoclopramide and acid suppressants within recent three days. No contraindication for intubation. 1. 2 Medicine and equipments 1.2. 1 Medicine:famotidine(trade name of Xin Fa Ding, Shanghai Sine pharmaceutical company.) 1. 2. 2 Equipments:pH monitor of dynamical Digitrapper MK III and Bilitec 2000 are all produced by Medtronic Synectics Medical company in Sweden. 1.3 Method:DThe level of PEEP, the score of MODS and APACHE II were evaluated on the day of study ;2) Acid and bile reflux monitoring beforeadministration;3)Reevaluating PEEP.MODS and APACHE II , acid and bile reflux monitoring after administration;4)On third day nasogastric tube was inserted to record the gastric residual volume of 24h during administration of famotidine.In our stu...
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