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Article(id=1208144414279578220, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1208144409313526368, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.2022.03.0299, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1622390400000, receivedDateStr=2021-05-31, revisedDate=null, revisedDateStr=null, acceptedDate=1627401600000, acceptedDateStr=2021-07-28, onlineDate=1765973674601, onlineDateStr=2025-12-17, pubDate=1648396800000, pubDateStr=2022-03-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1765973674601, onlineIssueDateStr=2025-12-17, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1765973674601, creator=13701087609, updateTime=1765973674601, updator=13701087609, issue=Issue{id=1208144409313526368, tenantId=1146029695717560320, journalId=1189873630562394117, year='2022', volume='47', issue='3', pageStart='213', pageEnd='319', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1765973673415, creator=13701087609, updateTime=1765974822867, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1208149230531756320, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1208144409313526368, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1208149230531756321, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1208144409313526368, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=299, endPage=304, ext={EN=ArticleExt(id=1208144414774506112, articleId=1208144414279578220, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Effect of analgesic drugs on acute gastrointestinal injury in critically ill patients, columnId=1190243275882729994, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Review, runingTitle=null, highlight=null, articleAbstract=

Gastrointestinal dysfunction is one of the initiating factors for multiple organ failure. The European Society of Intensive Care Medicine (ESICM) proposed the definition of acute gastrointestinal injury (AGI) to describe dysfunction of the gastrointestinal tract in critically ill patients. AGI occurs frequently in the intensive care unit (ICU) and associates with clinical outcomes of ICU patients. The incidence of pain is high in the ICU, and analgesic drugs can significantly improve the prognosis of patients. But the administration of analgesic drugs is an important factor affecting gastrointestinal function. So, in order to prevent AGI in high-risk patients, both analgesic needs and low impact on gastrointestinal function need to be taken into account before choices of opioids are finalized. This review briefly summarizes the mechanisms of AGI in ICU patients and the studies related to the effects of analgesics on gastrointestinal motility and barrier in ICU patients with opioids as the core, providing a reference for clinical selection.

, correspAuthors=Xi-Jing Zhang, authorNote=null, correspAuthorsNote=
*E-mail:
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胃肠道功能障碍是引起多脏器衰竭的始动因素之一，欧洲危重病医学会提出了急性胃肠损伤(AGI)这一概念，用于描述重症患者的胃肠道功能障碍。重症监护室(ICU)患者疼痛发生率高，镇痛药物使用较多，而镇痛药物是影响胃肠道功能的重要因素。因此，对于镇痛药物的选择，应做到在满足镇痛需求的同时对胃肠道功能影响较小，以防止高风险患者发生AGI。本文总结ICU患者AGI的发生机制，并以阿片类镇痛药物为核心，综述镇痛药物对ICU患者胃肠道动力及屏障影响的相关进展。

, correspAuthors=张西京, authorNote=null, correspAuthorsNote=
张西京，E-mail：
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闫云，医学硕士，主要从事镇痛与胃肠道功能的相关研究

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闫云，医学硕士，主要从事镇痛与胃肠道功能的相关研究

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闫云，医学硕士，主要从事镇痛与胃肠道功能的相关研究

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镇痛药物对重症患者急性胃肠损伤的影响研究进展
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闫云 , 陈宇 , 张西京 *
解放军医学杂志 | 综述 2022,47(3): 299-304
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解放军医学杂志 | 综述 2022, 47(3): 299-304
镇痛药物对重症患者急性胃肠损伤的影响研究进展
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闫云, 陈宇, 张西京*
作者信息
  • 空军军医大学附属第一医院重症医学科/麻醉与围术期医学科，西安 710000

    • 闫云，医学硕士，主要从事镇痛与胃肠道功能的相关研究

通讯作者:

张西京，E-mail：
Effect of analgesic drugs on acute gastrointestinal injury in critically ill patients
Yun Yan, Yu Chen, Xi-Jing Zhang*
Affiliations
  • Department of Critical Care Medicine, Xijing Hospital, Air Force Medical University, Xi’an 710000, China
出版时间: 2022-03-28 doi: 10.11855/j.issn.0577-7402.2022.03.0299
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摘要
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胃肠道功能障碍是引起多脏器衰竭的始动因素之一，欧洲危重病医学会提出了急性胃肠损伤(AGI)这一概念，用于描述重症患者的胃肠道功能障碍。重症监护室(ICU)患者疼痛发生率高，镇痛药物使用较多，而镇痛药物是影响胃肠道功能的重要因素。因此，对于镇痛药物的选择，应做到在满足镇痛需求的同时对胃肠道功能影响较小，以防止高风险患者发生AGI。本文总结ICU患者AGI的发生机制，并以阿片类镇痛药物为核心，综述镇痛药物对ICU患者胃肠道动力及屏障影响的相关进展。

急性胃肠损伤  /  镇痛药物  /  重症监护室  /  阿片类药物

Gastrointestinal dysfunction is one of the initiating factors for multiple organ failure. The European Society of Intensive Care Medicine (ESICM) proposed the definition of acute gastrointestinal injury (AGI) to describe dysfunction of the gastrointestinal tract in critically ill patients. AGI occurs frequently in the intensive care unit (ICU) and associates with clinical outcomes of ICU patients. The incidence of pain is high in the ICU, and analgesic drugs can significantly improve the prognosis of patients. But the administration of analgesic drugs is an important factor affecting gastrointestinal function. So, in order to prevent AGI in high-risk patients, both analgesic needs and low impact on gastrointestinal function need to be taken into account before choices of opioids are finalized. This review briefly summarizes the mechanisms of AGI in ICU patients and the studies related to the effects of analgesics on gastrointestinal motility and barrier in ICU patients with opioids as the core, providing a reference for clinical selection.

acute gastrointestinal injury  /  analgesics  /  intensive care unit  /  opioids
闫云, 陈宇, 张西京. 镇痛药物对重症患者急性胃肠损伤的影响研究进展. 解放军医学杂志, 2022 , 47 (3) : 299 -304 . DOI: 10.11855/j.issn.0577-7402.2022.03.0299
Yun Yan, Yu Chen, Xi-Jing Zhang. Effect of analgesic drugs on acute gastrointestinal injury in critically ill patients[J]. Medical Journal of Chinese People’s Liberation Army, 2022 , 47 (3) : 299 -304 . DOI: 10.11855/j.issn.0577-7402.2022.03.0299
正文
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胃肠道功能障碍与重症监护室(intensive care unit，ICU)患者的预后密切相关，但对于胃肠道功能障碍存在诸多不同定义，给科学研究及临床决策带来很大不便[1-2]。欧洲危重病医学会(European Society of Intensive Care Medicine，ESICM)基于胃肠道病理生理机制及循证医学证据，提出了急性胃肠损伤(acute gastrointestinal injury，AGI)的概念以描述ICU患者的胃肠道功能障碍[1]。AGI是指ICU患者因其急性疾病而导致的胃肠道功能障碍，按严重程度可分为4级[1]。AGI分级与ICU患者的临床结局密切相关，是其死亡的独立危险因素之一[3]。在新型冠状病毒肺炎(corona virus disease 2019，COVID-19)患者中，AGI的发生率高达86.7%，AGI分级越高，胃肠道损伤越严重，更容易进展为脓毒性休克，导致ICU停留时间及住院时间延长，病死率增高[4]。镇痛药物的使用是影响胃肠道功能的重要因素，因此对于镇痛药物的选择，应做到在满足镇痛需求的同时对胃肠道功能影响较小，以防止高风险患者发生AGI。本文以阿片类镇痛药物为核心，对AGI的发病机制及阿片类药物对ICU患者胃肠道功能影响的相关研究进行综述。
1 ICU镇痛药物选择
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镇痛是ICU管理的重要组成部分。50%~80%的ICU患者经历过中、重度疼痛[5-6]。ICU中引起疼痛的原因很多，包括疾病本身、有创操作(如动脉静脉穿刺)、日常护理操作等，同时，睡眠剥夺及无法交流等因素也会加重疼痛[6-7]。疼痛可对多个脏器产生不良影响，适当的镇痛管理可改善患者预后，但镇痛药的使用也可影响患者的胃肠道功能，尤其是ICU患者。
目前针对ICU疼痛常采用多模式镇痛管理方案，包括药物干预及非药物干预[8]。药物治疗主要包括阿片类药物及非阿片类辅助药物，如对乙酰氨基酚、非甾体抗炎药等[9]。对乙酰氨基酚是临床上常用的非阿片类药物，但存在肝损害、降低颅内灌注压等不良反应[6]，而且其对ICU患者的安全性及有效性尚无充足证据，指南对其推荐也是基于低质量证据[10]。非甾体抗炎药是临床常用的可有效治疗癌性疼痛及非癌性疼痛的非阿片类药物[10-11]，但其最明显的不良反应即为对胃肠道的影响，包括恶心、厌食、腹痛，甚至溃疡、穿孔及出血，可加重或直接导致AGI的发生，以非选择性环氧化酶(COX)抑制剂最严重。除造成胃肠道损伤及心血管事件外，非甾体抗炎药还可抑制血小板聚集、增加脑室出血风险。上述不良反应限制了其在ICU的使用[12-13]。因此，大多数ICU的镇痛药仍以阿片类药物为主，但其使用也可影响胃肠道功能[10]。本文主要简述阿片类药物对ICU患者胃肠道功能的影响。
2 ICU患者AGI的发生机制
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正常胃肠道功能取决于肠道屏障包括机械屏障、免疫屏障、化学屏障、生物屏障的完整性以及协调的胃肠道动力。ICU患者的原发疾病以及在ICU接受的各种治疗均可不同程度地影响患者胃肠道屏障的完整性及胃肠道动力，甚至最终引起肠缺血、胃肠道穿孔、消化道出血、腹腔间隔室综合征等危及生命的严重事件。
2.1 胃肠道屏障完整性被破坏
严重创伤、脓毒症、休克等造成的应激反应均可破坏肠道内皮细胞，增加肠道通透性，进而引起AGI。发生脓毒症时，升高的细胞因子如白细胞介素(interleukin，IL)-6、肿瘤坏死因子(tumor necrosis factor, TNF)-α等可通过降低claudin 2、claudin 5、occludin及胞质紧密粘连蛋白(zonula occludens-1，ZO-1)的表达导致细胞间紧密连接缺失，引起胃肠道机械屏障破坏。肌球蛋白轻链激酶激活可增加IL-6、TNF-α及IL-1β的水平，并可通过促进肌球蛋白轻链的磷酸化增加细胞旁连接的通透性。肠道通透性增加可通过正反馈进一步加剧全身炎症反应。脓毒症期间细胞因子水平的升高也可抑制肠道细胞再生，并以Toll样受体4(Toll-like receptor 4，TLR4)依赖的方式促进肠道细胞凋亡。严重创伤、休克等均可造成内脏低灌注，引起肠道内皮细胞发生凋亡，破坏肠道屏障，促进细胞因子及自由基的产生及释放，进一步加重消化道损伤，从而形成恶性循环，最终导致脓毒症、脓毒性休克及多器官功能障碍[14-15]。
此外，细胞因子也可破坏肠道化学屏障，减少肠道黏液层厚度及管腔覆盖面积[16]。胃肠道黏液层在胃肠道损伤后的修复及再生中起重要作用，对维持胃肠道屏障的完整性具有重要意义。上皮来源的免疫球蛋白A(IgA)参与了黏膜屏障的形成，肠道树突状细胞等作为抗原提呈细胞的感受体，发挥了局部免疫作用[17]。早期肠内营养可保护胃肠道的免疫功能，而长期饥饿会导致促炎因子改变及细菌过度生长[18]。正常的肠道细菌在维持肠道黏膜屏障方面起着至关重要的作用。肠道菌群与疾病的严重程度有关。重症患者的肠道菌群密度及多样性在危重症疾病发生的几小时内就会发生改变[19]。肠道微生物群具有免疫调节特性，抗生素以及ICU中的其他常用药物均可干扰肠道微生物群[20]。重症患者肠道菌群分布及密度严重受损的原因包括机体所处环境、基因表达的改变、药物、营养物质及给予营养的途径等[21-22]。危重疾病也会导致微生物群之间的平衡被破坏，导致病原菌占优势、毒力及抗药性增强等改变[23]。
2.2 胃肠道动力失衡
大多重症疾病可造成胃肠道动力障碍，如腹部手术、脓毒症等。AGI的多数症状及体征与胃肠道动力障碍密切相关。腹部手术可造成不同部位的胃肠道动力障碍。上消化道手术术后，易发生食管括约肌功能障碍[24]。结直肠手术术后，吻合口漏发生率达3%，是最严重的术后并发症[25]。对于外科术后患者而言，围手术期液体输入量与术中失血量是术后麻痹性肠梗阻及胃肠道功能恢复的独立影响因素[26-27]。给健康小鼠输注脓毒症小鼠的肠道淋巴液，可导致其胃动力降低57%，肠道动力降低21%[28]。与此同时，肠源性炎性因子如TNF-α可直接抑制肠道平滑肌收缩，并激活抑制性神经元通路，减弱胃肠道动力。此外，肠道激素也参与了胃肠道动力的调节。
59%的急性胰腺炎(acute pancreatitis，AP)患者伴有肠道屏障损伤，肠道黏膜通透性增加[29]。AP患者同样存在胃肠道动力异常，包括胃排空受损及肠道转运时间延长。AP患者的AGI分级可用作其病死率的预测因素[30]。此外，有研究对6例危重患者的结肠进行活检发现，重症患者的黏膜厚度降低且Cajal间质细胞(interstitial cells of Cajal，ICC)显著减少，表明危重疾病可引起ICC减少且这一改变与胃肠道动力异常相关。脓毒症也可造成肌间神经丛ICC凋亡。ICC丢失与一氧化氮合酶的降低有关，高水平的炎性因子也可减少一氧化氮合酶及ICC[31]。肠道水肿引起的细胞骨架改变参与了肠道动力障碍的发生，肠道水肿本身也可通过造成内毒素血症损害肠道动力。
3 阿片类药物对AGI的影响
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3.1 阿片类药物引起AGI的机制
镇痛是ICU管理的重要组成部分，适当的镇痛可改善患者预后，但镇痛药物的使用同样是影响AGI的重要因素。ICU患者的胃肠道易受损，因此其镇痛药物的选择至关重要。阿片类药物是最常用的治疗中、重度疼痛的药物，但可通过影响胃肠道动力及肠道屏障的完整性来影响AGI。阿片受体广泛存在于中枢神经系统、外周及肠道神经系统，主要包括μ受体、δ受体、κ受体[32]。抑制肠道神经元兴奋性及神经递质释放是阿片类药物调节胃肠道功能的主要方式。不同类型的阿片受体可对胃肠道功能产生不同程度的影响。阿片受体主要分布在肠道肌间神经元及黏膜下神经元。μ受体激动剂与δ受体激动剂均可抑制乙酰胆碱及血管活性肠肽，减少Cl–释放及渗透性水运动；抑制神经肌肉传递，增加括约肌张力，减弱推动性收缩；还可抑制ICC，破坏肠道推动性收缩模式，影响肠道动力。κ受体激动剂通过抑制胆碱能及非胆碱能兴奋性神经递质，抑制肠道平滑肌收缩，但特异性敲除κ受体激动剂对这一收缩作用并无明显影响[33-34]。阿片受体激动剂通过调节肠道神经系统的神经递质以及肠道神经元的兴奋性，抑制胃肠道推动性收缩，增加括约肌张力，延缓胃排空，增加肠道转运时间。胃肠道动力受抑制也可造成肠道水电解质吸收增加、致病菌过度增殖，影响肠道菌群多样性，增加胃肠道感染的发生风险，进一步破坏胃肠道屏障，加重AGI。
3.2 阿片类药物对胃肠道动力的影响
阿片类药物通过阿片受体介导其对胃肠道动力的抑制，其中μ受体发挥主要作用。吗啡是经典的纯μ受体激动剂，可引起胃动力协调性异常[35]。一项对比吗啡联合咪达唑仑与单用丙泊酚对重症患者镇静效果的研究发现，吗啡联合咪达唑仑延长胃排空的时间是单用丙泊酚的2倍[36]。胃排空延迟可严重影响胃残余量，大量胃内容物残余是造成肠内营养不耐受的重要原因[37]。但关于吗啡对ICU患者胃肠道功能影响的研究结果并不一致。有研究表明，吗啡可增加ICU患者发生便秘的风险；但也有研究提出阿片类药物的使用并不是ICU患者便秘的危险因素，且外周阿片受体拮抗剂甲基纳曲酮并未降低ICU患者的便秘发生率[38-39]。瑞芬太尼是超短效μ受体激动剂，研究表明其可引起食管动力障碍，麻醉中使用瑞芬太尼可增加误吸的发生风险[40-42]。在一项比较围手术期胸段硬膜外镇痛与术后使用舒芬太尼进行自控静脉镇痛对胰腺术后患者疼痛控制效果的试验中发现，两组术后30 d内胰瘘、胆汁渗漏、胃排空延迟、胃肠道出血及术后肠梗阻的发生情况无统计学差异[43]。同时有研究表明，术中及术后使用阿片类药物对麻痹性肠梗阻及胃肠道功能的恢复无明显影响[27]。
κ受体激动剂对胃肠道的抑制作用远弱于μ受体激动剂[34]。纳布啡属于阿片受体激动拮抗药物，主要通过激动κ受体、部分拮抗μ受体发挥药理作用。纳布啡能通过激活κ受体产生镇痛作用，同时通过部分拮抗μ受体，明显减轻μ受体介导的胃肠道抑制作用。动物实验证明，纳布啡呈剂量依赖性地抑制小鼠的胃排空及胃肠道转运作用，但其抑制作用较轻，且在胃排空及胃肠道转运中，纳布啡剂量反应曲线的斜率明显低于吗啡[44]。此外，纳布啡可明显逆转吗啡对胃肠道的抑制作用。有研究对分娩产妇术前给予纳布啡并观察其对肠道动力的影响，结果显示纳布啡对肠道动力的抑制作用明显弱于吗啡[45]。布托啡诺也属于阿片受体部分激动拮抗药，主要激动κ受体[46]。单次静脉注射布托啡诺可抑制胃肠道动力，相比于单次静脉注射，持续输注布托啡诺对胃肠道动力的抑制作用较弱，但也会降低其镇痛效能[47]。有研究给健康马连续输注96 h布托啡诺，在最后24 h观察，可见其粪便重量减少，当与其他药物如氯胺酮、利多卡因合用时，粪便重量进一步减少；但短时间(2 h)持续输注布托啡诺对马的十二指肠动力无明显影响[48-49]。布托啡诺对胃肠道动力的影响与输注方式及剂量有关，低剂量、持续输注可降低其对胃肠道的抑制作用[47]。
3.3 阿片类药物对胃肠道屏障完整性的影响
镇痛药物不仅可抑制胃肠道动力，还可影响肠道屏障的完整性。吗啡可上调小鼠小肠内皮细胞TLR的表达，TLR激活可引起内皮细胞间紧密连接破坏，使肠道通透性增加，进而导致小肠细菌移位及小肠炎症，同时引起肠道菌群多样性的改变[50]。ICU患者粪便中的菌群多样性严重受损，致病菌及真菌过度繁殖，阿片类药物的使用与这一改变相关[51-52]。致病肠道细菌可到达肠道黏膜，激活机体免疫反应，释放炎性因子，进一步加重肠道损伤，同时促进肠系膜淋巴系统释放损伤相关分子模式(damage associated molecular patterns，DAMPs)进入血液循环，最终引起多脏器功能障碍。而有益肠道细菌嗜黏蛋白-艾克曼菌的增加可促进内皮细胞连接蛋白ZO-1及闭合蛋白的表达，增厚肠道黏膜层，维持肠道屏障的正常功能。同时嗜黏蛋白-艾克曼菌可产生Amuc-100蛋白，参与肠道黏膜的免疫稳态[53-54]。
阿片类药物的使用也可加重感染。阿片类药物可进入细菌胞质，激活群体感应调节系统，增加细菌毒力，促进致病菌对机体的感染能力[52]。啮齿柠檬酸杆菌单独感染无法破坏肠道黏膜及肠道紧密连接蛋白ZO-1，但若加用吗啡可破坏肠道内皮细胞屏障，并可改变肠道菌群的多样性[55]。肠道屏障的破坏可使肠道细菌经内皮细胞移位，增加肠源性细菌的感染，加速疾病进程。吗啡还可调节肠道免疫细胞。经吗啡处理的感染啮齿柠檬酸杆菌的小鼠CD4+ T细胞数量及促炎因子IL-17A均明显减少。IL-17A能维持正常肠道黏膜的免疫功能。一项回顾性队列研究发现，与既往无免疫抑制疾病的患者相比，既往有免疫抑制疾病的患者使用长效阿片类药物发生严重感染的风险增高[56]。同时有研究表明，阿片类药物的使用与烧伤患者的感染风险相关，高剂量摄入阿片类药物会增加烧伤面积<26%全身表面积患者的感染风险[57]。此外，大多数阿片类药物对心脏收缩力几乎没有直接的负面影响，以镇痛剂量使用时，很少会导致低血压及晕厥等[58]。因此，阿片类药物通过降低胃肠道灌注对胃肠道功能的影响较小。
3.4 阿片类药物的临床选择
AGI分级影响ICU患者的预后[3]。为避免引起或加重AGI，ICU患者镇痛药物的选择至关重要。目前，ICU镇痛药物以阿片类为主，但关于阿片类药物对ICU患者胃肠道功能影响的研究较少。从既往研究可知，阿片类药物主要通过抑制胃肠道动力来影响胃肠道功能[59]。此外，阿片类药物可使肠道对致病菌的敏感性增加，增加致病菌对肠道的侵袭能力，也可改变肠道菌群的分布及多样性，从而影响胃肠道功能[55]。阿片类药物通过不同受体影响胃肠道动力，其中μ受体是最主要的受体，κ受体可介导镇痛效应，且对胃肠道功能的影响较小。虽然目前关于阿片受体激动拮抗药物纳布啡及布托啡诺对ICU患者胃肠道功能影响的临床研究较少，但动物实验及部分临床试验均证实其对胃肠道功能的影响比纯μ受体激动药物小[45,47]。因此，在对ICU患者阿片类镇痛药物的选择中，为避免对胃肠道功能的严重影响，应优先选择阿片受体激动拮抗药物或κ受体激动药物。此外，对于伴有免疫抑制的患者，阿片类药物的选择应避免进一步加重免疫抑制及感染风险[60]。
4 总结与展望
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ICU患者的AGI发生率高，且一旦发生预后较差，早期对其进行干预对改善ICU患者的预后具有重要意义。镇痛药物可通过改变胃肠道动力、肠道屏障、肠道菌群、肠系膜灌注及局部免疫等影响胃肠道功能。而阿片类药物主要通过改变胃肠道动力、增加肠道致病菌群毒力、破坏肠道屏障来影响胃肠道功能。既往关于阿片类药物对胃肠道的影响研究较少，但均表明其可不同程度地影响胃肠道功能。鉴于ICU患者疼痛发生率高，镇痛药物的使用必不可少，为同时兼顾镇痛需求以及减少对胃肠道功能的影响，镇痛药物的选择可根据指南推荐进行：使用多模式镇痛管理，减少阿片类药物的使用。在阿片类药物选择方面，可优先选择对胃肠道功能影响较小的阿片受体激动拮抗药物及κ受体激动剂。此外，ICU患者本身的疾病以及ICU内的治疗均可不同程度影响患者的胃肠道功能造成AGI，所以很难区分是这些因素还是阿片类药物的使用造成或加重了胃肠道功能障碍。因此，还需更多研究来明确在ICU环境中不同种类阿片类药物、药物使用时长、输注方式等对AGI的影响及其影响程度，同时尚需开发不良反应更小的新型药物以实现更好、更安全的临床镇痛。
基金
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  • 国家自然科学基金(81871603)
  • 陕西省重点研发计划(2020ZDXM-SF-002)
文献
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2022年第47卷第3期
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doi: 10.11855/j.issn.0577-7402.2022.03.0299
  • 接收时间：2021-05-31
  • 首发时间：2025-12-17
  • 出版时间：2022-03-28
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  • 收稿日期：2021-05-31
  • 录用日期：2021-07-28
基金
National Natural Science Foundation of China(81871603)
国家自然科学基金(81871603)
Key Research and Development Program of Shaanxi Province(2020ZDXM-SF-002)
陕西省重点研发计划(2020ZDXM-SF-002)
作者信息
    空军军医大学附属第一医院重症医学科/麻醉与围术期医学科，西安 710000

通讯作者:

张西京，E-mail：
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https://castjournals.cast.org.cn/joweb/jfjyxzz/CN/10.11855/j.issn.0577-7402.2022.03.0299
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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