床旁盲插鼻肠管在重症患者肠内营养中的应用及护理  

The application of bedside blind placement of nasal-intestinal tube in enteral nutrition support for critically ill patients and related nursing management

作　　者：王亚芳[1] 周海霞[1] 

机构地区：[1]江苏省常州市第一人民医院重症医学科,江苏常州213003

出　　处：《中西医结合护理（中英文）》2017年第12期106-109,共4页Journal of Clinical Nursing in Practice

摘　　要：目的探讨床旁盲插鼻肠管在重症患者肠内营养中的应用价值,总结其护理要点。方法 160例重症患者根据肠内营养支持方式不同分为鼻胃管组和鼻肠管组,鼻胃管组80例常规经鼻留置胃管,鼻肠管组80例采用床旁盲插鼻肠管。分别于入院第1、14天检测患者血清转铁蛋白(TF)、前清蛋白(PA)及清蛋白(ALB)水平;观察2组腹胀腹泻、恶心呕吐、返流误吸及肺部感染等发生情况;统计2组机械通气时间、ICU入住时间及30 d内ICU再入住率。结果入院第1天,2组PA、TF、ALB水平差异无统计学意义(P>0.05);入院第14天,2组PA、TF、ALB较入院第1天降低(P<0.05),鼻肠管组PA、TF高于鼻胃管组(P<0.05)。鼻肠管组返流、误吸发生率及肺部感染率均低于鼻胃管组(P<0.05)。鼻肠管组机械通气时间、ICU入住时间短于鼻胃管组(P<0.05),且鼻肠管组30 d内ICU再入住率低于鼻胃管组(P<0.05)。结论床旁盲插鼻肠管可有效改善重症患者营养指标,降低返流、误吸及肺部感染发生率,细致的护理是实现这一目标的重要保证。Objective To investigate the application value of bedside blind placement of nasalintestinal tube in enteral nutrition support for critically ill patients,and to summarize the main points of nursing management. Methods Totally 160 critical patients admitted to ICU were selected as study subjects. According to different nutritional support methods,they were divided into the nasogastric tube group( n = 80) and the nasal-intestinal tube group( n = 80,by bedside blind placement). Levels of serum transferrin( TF),prealbumin( PA) and albumin( ALB) were detected on the 1 st and 14 th day after admission. The incidence of abdominal distension and diarrhea,nausea and vomiting,regurgitation and aspiration and pulmonary infection in the two groups was observed and recorded. The duration of mechanical ventilation,length of ICU stay and the readmission rate in ICU within 30 days were statistically analyzed. Results Levels of PA and TF in the nasal-intestinal tube group were significantly higher than those in the nasogastric tube group on the 14 th day after admission( P < 0. 05). The incidence of reflux,aspiration and pulmonary infection in the nasal-intestinal tube group were significantly lower than those in the nasogastric tube group( 15. 00%,22. 50% vs 53. 75%,48. 75%)( P < 0. 05). The duration of mechanical ventilation and length of ICU stay of the nasal-intestinal tube group were shorter than those of the nasogastric tube group( P < 0. 05),and the readmission rate of in ICU within 30 days was significantly lower than that in the nasogastric tube group( P < 0. 05). Conclusion The enteral nutrition support by bedside blind placement of nasal-intestinal tube can effectively improve the nutritional indexes in critical patients,and nursing interventions on nasal-intestinal tube can reduce the risk of regurgitation,aspiration and pulmonary infection.

关 键 词：盲插法 鼻肠管 肠内营养 鼻胃管 

分 类 号：R473.5[医药卫生—护理学]