经鼻盲放幽门后营养管实施胃液回输在ICU中的应用研究  

Application of nasorhal pylorus after the naso pylorus gastric tube reinfusion in ICU

作　　者：贾雪丽[1] Jia Xueli(Department of Intensive Medicine,the Second Hospital of Anhui Medical University,Hefei 230001,China)

机构地区：[1]安徽医科大学第二附属医院重症医学科一病区,合肥230001

出　　处：《中国实用护理杂志》2019年第9期708-712,共5页Chinese Journal of Practical Nursing

基　　金：安徽医科大学校科学研究基金资助项目(2017xkj048).

摘　　要：目的总结经鼻盲放幽门后营养管的经验及通过此途径实施胃液回输技术在危重患者治疗中的应用价值与护理策略。方法选取安徽医科大学第二附属医院ICU于2016年2月至2018年4月收治的100例胃十二指肠潴留患者,胃肠功能障碍分级为Ⅱ~Ⅲ级,且每日胃肠减压量≥500ml的患者作为研究对象,全部采用经鼻盲放幽门后营养管,按照随机数字表法随机分成试验组和对照组,每组各50例。试验组在常规补液、预防/控制感染、器官功能支持保护等治疗基础上,应用自制改良的密闭式自体胃液回输装置行胃十二指肠液小肠回输联合肠内营养治疗;对照组的患者仅实施肠内营养,不进行胃液回输。监测患者行胃液回输治疗期间的各项指标,包括水电解质紊乱和酸碱平衡失调,以及达到目标全肠内营养所需时间、肠道菌群失调情况、平均胃液回输天数、喂养不耐受情况等,记录实施该胃液回输方法过程中出现的并发症及经鼻盲放幽门后营养管的一次成功率,并分析其原因。结果经鼻盲放幽门后营养管一次成功率91%;失败原因主要包括患者不配合、体位受限等。2组在菌群失调、实施过程中发生误吸、原发性代谢性酸碱平衡紊乱发生率等指标比较差异无统计学意义(P>0.05);试验组严重电解质紊乱、喂养不耐受的患者数和达到全肠内营养所需天数、平均胃液回输天数分别为1、6、5、(5.74±1.42)d,明显少于对照组的8、15、19、(13.94±3.53)d,差异有统计学意义(χ^2=-15.239~7.294,P<0.05或0.01)。结论在ICU患者中经鼻盲放幽门后营养管并在此基础上实施"密闭式"胃液回输,操作简单,护士易于掌握,降低患者内环境紊乱和喂养不耐受的发生率,适合在临床推广。ObjectiveTo summarize the experience of naso pyloric posterior blind feeding tube and the application value and nursing strategy of gastric fluid reinfusion technique in critically ill patients.MethodsA total of 100 patients with gastroduodenal retention were selected from February 2016 to April 2018 in our hospital.The gastrointestinal dysfunction was classified as class II to grade II,and the daily gastrointestinal decompression amount was more than 500 ml as the research object.All the 100 patients were treated with nasal blinded pylorus tube and were randomly divided into two groups.Based on prevention/control infection and organ function support protection and so on,the self-made modified closed autologous gastric juice retransfusion system was used for enteroenteroenteral retransmission and enteral nutrition treatment,while the patients in the control group only carried out enteral nutrition and did not carry out gastric juice transfusion.The indexes of the patients during the treatment of gastric juice were monitored,including water electrolyte disturbance and acid-base balance disorder,the time required for the total enteral nutrition,the imbalance of intestinal flora,the average number of gastric fluid return and the feeding intolerance,etc.,and the complications and the complications during the process of the gastric juice transfusion were recorded.The success rate of nutrient tube after blind pylorus pylorus was analyzed and its causes were analyzed.ResultsAfter naso pylorus pylorus,the success rate of the nutrient tube was 91%.The main reasons for failure included the patients is intolerant of nutrient tube and limited body position.There were no statistical difference in the incidence of dysbacteriosis,aspiration and primary metabolic acid-base disturbance between the experimental group and the control group(P>0.05).In the experimental group,the number of patients with serious electrolyte disturbance,feeding intolerance and the number of days required to achieve total enteral nutrition,and the averag

关 键 词：幽门后喂养 胃液回输 胃肠功能障碍 

分 类 号：R473.5[医药卫生—护理学]