对危重患者使用双导丝置管法补救性床边盲插螺旋型鼻肠管的方法及安全性研究  

The feasibility study of using the dual stylet method as a bedside measure infacilitating insertion of the spiral distal end nasal-enteral feeding tube in critically ill patients

作　　者：陈纯波[1] 叶珩[1] 曾红科[1] 龙怡[1] 孙诚[1] 李辉[1] 方明[1] 蓝惠兰[1] 黎春常[1] 

机构地区：[1]广东省人民医院急危重症医学部,广州510080

出　　处：《中国危重病急救医学》2008年第6期335-337,共3页Chinese Critical Care Medicine

基　　金：广东省科技计划基金资助项目（2006B36007016）;广东省医学科研基金资助项目（A2007004）

摘　　要：目的介绍对危重患者采用双导丝置管法补救性床边盲插螺旋型鼻肠管的方法，探讨其安全性和有效性。方法选择2005年7月-2007年3月50例放置螺旋型鼻肠管而不能自行通过幽门的危重患者，在心电监测下，采用双导丝置管法补救性床边盲插螺旋型鼻肠管，观察幽门后置管成功率和并发症发生率。结果50例患者的平均置管时间为（24．5±4．9）min，置管成功率为82．0％（41／50），2006年7月-2007年3月治疗的后25例患者置管成功率为96．0％（24／25），明显高于2005年7月-2006年7月治疗的前25例[68．0％（17／25）]，差异有统计学意义（P〈0．05）。41例置管成功患者的平均置管深度为（85．3±2．9）cm。置管过程中引起患者心率加快[（116．7±18．5）次／min比（107．6±14．2）次／min，P〈0．01]、呼吸频率加快[（22．4±4．6）次／min比（21．3±3．9）次／min，P〈0．01]、平均动脉压升高[（86．7±10．7）mmHg比（82．0±7．7）mmHg，1mmHg-0．133kPa，P〈0．01]，置管结束后1h上述指标恢复到置管前水平；置管对脉搏血氧饱和度无明显影响；未发生严重置管并发症。结论心电监测下，对危重患者采用双导丝置管法补救性床边盲插螺旋型鼻肠管是安全、有效的。Objective To evaluate the feasibility of using the dual styler method as a bedside measure after unsuccessful of the spiral distal end nasal-enteral feeding tubes into the duodenum in critically ill patients. Methods Spiral distal end nasal-enteral feeding tubes were introduced into the stomach of 50 critically ill patients but unable to pass through the pylorus from July 2005 to March 2007. Under electrocardiographic monitoring, the dual styler method was used as a bedside measure to facilitate the passage. The duration, successful ratio, and complication of the procedure were recorded. Results This procedure took an average time of （24.5 ± 4.9） minutes. The success rate of passing through the pylorus was 82.0% （41/50）. The success rate of the latter 25 cases treated from July 2006 to March 2007 was significantly higher than that of the former 25 cases treated from July 2005 to July 2006 [96.0% （24/25） vs. 68.0% （17/25）, P〈0.05]. The average insertion distance of the 41 successful cases was （85.3±2.9）cm. Heart rate （HR） during the procedure was （116.7±18.5） beats per minute, that before insertion was （107.6±14.2） beats per minute （P〈0.01）, respiratory rate （RR） was （22.4±4.6） breaths per minute during the procedure and （21.3±3.9） breaths per minute （P〈0.01） before the procedure and mean arterial pressure （MAP） （86.7±10.7） mm Hg during and （82.0±7.7）mmHg （1 mmHg=0.133 kPa, P〈0.01） before the procedure. But there was no change in arterial oxygen saturation （SaO2）. No severe complication was noted. Conclusion The dual styler method can be used effectively and safely in critically ill patients as a bedside measure after placement of the spiral distal end nasal-enteral feeding tubes.

关 键 词：肠道营养 插管法 螺旋型鼻肠管 危重病 

分 类 号：R459.7[医药卫生—急诊医学]