侧俯卧位留置胃管在昏迷患者中的应用效果研究  

Application and Efficacy of Nasogastric Intubation in the Lateral-prone Position in Coma Patients

作　　者：葛春燕[1] 赵旺淼[1] 张万增[1] 孙昭胜[1] 李晓卫[1] GE Chun-yan;ZHAO Wang-miao;ZHANG Wan-zeng;SUN Zhao-sheng;LI Xiao-wei(Department of Neurosurgery,Harrison International Peace Hospital,Hengshui 053000,China)

机构地区：[1]哈励逊国际和平医院神经外科,河北省衡水市053000

出　　处：《中国全科医学》2018年第11期1349-1352,共4页Chinese General Practice

基　　金：河北省科技计划项目(16277799D)

摘　　要：目的探讨侧俯卧位留置胃管在昏迷患者中的临床应用及效果。方法选取2014年9月—2016年9月哈励逊国际和平医院神经外科神经重症监护病房收治的自发性脑出血昏迷患者110例,应用随机排列表,将患者分为常规法置管组(A组,54例)和侧俯卧位置管组(B组,56例)。A组采用常规方法留置胃管,B组采用侧俯卧位留置胃管。比较两组一次性置管成功率、总置管成功率、置管时间以及并发症发生率。结果两组总置管成功率比较,差异无统计学意义(P>0.05);B组一次性置管成功率高于A组(χ~2=8.245,P=0.004);B组置管时间短于A组(t=5.502,P<0.001)。A组中置管失败的患者转变为侧俯卧位后,均成功留置胃管;B组中1例患者置管失败后,在可视喉镜辅助下成功置管。B组干呕、呛咳、黏膜出血发生率均低于A组(χ~2=8.937、4.599、8.901,P<0.05)。结论侧俯卧位留置胃管的成功率高,操作简单,能够缩短置管时间,降低并发症发生率,适合昏迷患者使用。Objective To explore the clinical application and efficacy of nasogastric tube intubation in the lateralprone position in coma patients.Methods The study cohort included 110 spontaneous intracerebral hemorrhage coma patients who were admitted and treated in the Neurosurgical Intensive Care Unit of the Harrison International Peace Hospital between September 2014 and September 2016.The patients were divided into two groups by the random number table method:a conventional insertion group(group A,n=54)and a lateral-prone position insertion group(group B,n=56).A nasogastric tube was inserted by the conventional insertion method in group A and the lateral-prone position in group B.The success rate of one-time insertion,overall success rate of insertion,insertion time,and the incidence of complications were compared between the two groups.Results There was no significant difference in the overall success rates of insertion between the two groups(P>0.05).The one-time insertion success rate was greater and the insertion time was significantly shorter in group B than group A(χ2=8.245,P=0.004;t=5.502,P<0.001).When the conventional insertion method failed for patients in group A,tube insertion was successful when changed to the lateral-prone position.Failure of tube insertion by the lateral-prone position for one patient in group B was successfully completed with visual laryngoscope.The incidences of retching,choking,and mucosal bleeding were significantly lower in group B than group A(χ2=8.937,χ2=4.599,χ2=8.901,P<0.05).Conclusion Nasogastric intubation had a higher success rate in the lateral-prone position than with the conventional insertion method.In the lateral-prone position,nasogastric intubation is relatively simple,can shorten the insertion time,and reduce the incidence of complications.Intubation by the lateral-prone position is appropriate for coma patients.

关 键 词：插管法 胃肠 侧俯卧位 昏迷 舌后坠 

分 类 号：R472.91[医药卫生—护理学]