超声辅助螺旋形鼻肠管置入对严重创伤病人血流动力学及应激反应的影响  

The effect of ultrasound-assisted spiral nasointestinal tube placem ent on stress response and hemodynamics in patients with severe trauma

作　　者：朱瑞 徐凤玲 付红 高业兰 邵敏 ZHU Rui;XüFeng-ling;FU Hong;GAO Ye-lan;SHAO Min(The first affiliated hospital of Anhui medical university,Hefei 230022,Anhui,China)

机构地区：[1]安徽医科大学第一附属医院

出　　处：《肠外与肠内营养》2019年第5期281-285,共5页Parenteral & Enteral Nutrition

摘　　要：目的:探讨超声辅助下螺旋形鼻肠管置入对严重创伤病人血流动力学及应激反应的影响。方法:将安徽医科大学第一附属医院重症医学科收住的62例严重创伤病人按随机数字表法分为超声辅助留置螺旋形鼻肠管组(试验组)和床旁盲插螺旋形鼻肠管组(对照组),每组31例。比较两组置管准确率、置管时间、置管过程中呕吐、胃肠道出血、返流、误吸、导管异位、心律失常等并发症的发生情况,以及置管前(T0)、导管前端置入食管时(T1)、置入胃内时(T2)、过幽门时(T3),置管后5min(T4)、10min(T5)、15 min(T6)时病人平均动脉压(MAP)、心率(HR)、血糖(Glu)、唾液皮质醇(Cort)等应激指标的变化。结果:试验组置管准确率(94.2%)显著高于对照组(86.7%),差异有统计学意义。试验组鼻肠管置管时间平均为(21.6±7.2)min,对照组鼻肠管置管时间平均为(47.2±6.4)min,差异有统计学意义(P<0.05)。两组在置管过程中,呕吐、返流、误吸、胃肠道出血、心律失常发生率比较差异无统计学意义(P>0.05),而两组导管异位发生率比较差异有统计学意义(P<0.05)。两组在T0时MAP、HR、Glu、Cort比较差异均无统计学意义(P>0.05)。与T0相比较,对照组在T1~T6时刻MAP、HR、Glu、Cort均较置管前升高,差异均有统计学意义(P<0.05);试验组在T1~T6时刻MAP、HR、Glu、Cort均较置管前无显著升高(P>0.05)。两组在T1~T5时间点比较试验组MAP、HR显著低于对照组(P<0.05),但在T6时刻两组差异无统计学意义(P>0.05),但在T6时刻试验组Glu、Cort显著低于对照组(P<0.05)。结论:超声辅助螺旋形鼻肠管置入方式置管准确率高、耗时少、导管异位发生率低、对严重创伤病人产生应激反应轻,是安全且理想的置管方式。Objective:To investigate the effect of ultrasound-assisted spiral nasointestinal tube placement on stress response and hemodynamics in patients with severe trauma.Methods:62 cases of patients with severe trauma admitted to the Department of Critical Care Medicine of the First Affiliated Hospital of Anhui Medical University were randomly divided into ultrasound-assisted indwelling spiral nasointestinal tube group(experimental group)and bedside blind indwelling spiral nasointestinal tube group(control group),with 31 cases in each group.The incidence of complications such as catheterization accuracy,catheterization time,vomiting,gastrointestinal bleeding,reflux,aspiration,catheter ectopic and arrhythmia were compared between the two groups.Before and after the catheter was placed in the esophagus,stomach and pylorus,the mean arterial pressure(MAP),heart rate(HR),blood glucose(Glu)and salivary cortisol(Cort)were recorded.Results:The successful rate of placement was 94.2%in the experimental group while 86.7%in the control group(P<0.05).The average time of tube placement was(21.6±7.2)min in the experimental group and 47.2±6.4min in the control group(P<0.05).There was no significant difference in the incidence of vomiting,reflux,aspiration,hemorrhage and arrhythmia between the two groups(P>0.05),but the ectopic incidence between the two groups was statistically significant(P<0.05).There were no significant differences in Glu,Cort,HR and MAP between the two groups at T0(P>0.05).Compared with T0,Glu,Cort,HR and MAP in the control group were significantly higher at T1~T6 compared with that before catheterization(P<0.05).Glu,Cort,HR and MAP in the experimental group showed no significant increase at T1~T6 compared with that before catheterization(P>0.05).There were significant differences in HR and MAP between the two groups at T1~T5(P<0.05).However,at the moment of T6,the differences in Glu and Cort between the two groups were statistically significant(P<0.05),while the differences in HR and MAP were not statistically si

关 键 词：超声辅助 鼻肠管 创伤 应激反应 

分 类 号：R459.3[医药卫生—治疗学]