不同胃肠减压方式对颅脑损伤患者鼻饲反流误吸的影响  

Effect of different gastrointestinal decompression methods on reflux and aspiration during tube feeding in patients with traumatic brain injury

作　　者：董向燕 孙菊芳[2] 周兴梅[2] 李岩[2] 李超[3] 陶然[4] 常健[4] 方芳[4] 彭南海[5] 陈利群[1] 

机构地区：[1]复旦大学护理学院,上海200032 [2]上海市第一人民医院危重病科 [3]上海市第一人民医院神经外科 [4]上海市第一人民医院护理部 [5]南京军区南京总医院普外科研究所

出　　处：《护理学杂志》2018年第4期42-46,共5页Journal of Nursing Science

摘　　要：目的比较持续和间断两种胃肠减压方式降低颅脑损伤患者鼻饲反流、误吸的效果,为临床实施最佳胃肠减压方式提供依据。方法将入选的45例颅脑损伤患者随机分为持续胃肠减压组(持续组,23例)和间断胃肠减压组(间断组,22例),连续干预7d。每日收集两组咽喉部及支气管分泌物各6次,检测分泌物中的胃蛋白酶,比较两组反流、误吸、电解质紊乱及胃液pH异常发生情况。结果持续组反流、误吸发生率分别是12.63%和8.80%,间断组分别是19.37%和12.99%,两组比较,差异有统计学意义(均P<0.01);两组血电解质紊乱发生率及胃液pH值比较,差异无统计学意义(均P>0.05)。结论持续胃肠减压能有效降低颅脑损伤患者鼻饲期间反流、误吸的发生,短期的持续胃肠减压并不会增加电解质紊乱及胃液pH值异常发生率。Objective To compare the effect of continuous versus intermittent gastrointestinal decompression on reflux and aspiration during tube feeding in patients with traumatic brain injury（TBI）,and to provide reference for clinical workers. Methods A total of 45 patients were randomly divided into two groups,who received a tube feeding therapy for 7 days. The continuous group（n = 23） were subjected to continuous gastrointestinal decompression,while the intermittent group（n = 22） to an intermittent gastrointestinal decompression scheme.The secretions in the throat and bronchi of each patient were collected 6 times/day,and were subsequently mounted for pepsin evaluation.The frequencies of reflux and aspiration were compared between the two groups. Serum electrolytes and p H values of gastric fluid were assessed. Results The incidence rates of reflux and aspiration in the intermittent group were 19. 37% and 12. 99% respectively,significantly higher than the continuous group（12. 63% and 8. 80%）（P〈0. 01 for both）. No significant differences were overserved between the two groups in term of serum electrolyte disturbance and pH values of gastric juice（P〉0. 05 for both）. Conclusion Continuous gastrointestinal decompression could effectively reduce the frequency of reflux and aspiration during tube feeding therapy in TBI patients. The short-term application of continuous gastrointestinal decompression might not lead to disturbance of acid-base and electrolytes,or abnormal pH values of gastric juice.

关 键 词：颅脑损伤 鼻饲 空肠营养 胃肠减压 反流 误吸 电解质紊乱 胃液PH值 

分 类 号：R473.6[医药卫生—护理学] R471[医药卫生—临床医学]