神经外科昏迷患者鼻饲中发生误吸的原因分析与护理对策  

Analysis on the causes of aspiration and nursing measures in the patients with neurosurgical coma during nasal feeding

作　　者：茅彦[1] 汪莉莉 徐玲玲 MAO Yan;WANG Lili;XU Lingling(Department of Neurosurgery,Eastern Branch of Ningbo Medical Center Lihuili Hospital,Ningbo315040,China)

机构地区：[1]宁波市医疗中心李惠利医院东部院区神经外科,浙江宁波315040

出　　处：《中国现代医生》2021年第14期178-181,共4页China Modern Doctor

基　　金：浙江省中医药科技计划项目(20202B228)。

摘　　要：目的研究重型颅脑损伤昏迷患者在胃肠内营养中发生误吸原因及其预防护理对策。方法采用回顾性分析选取我科2018年1月至2019年6月收治的重型颅脑损伤患者,其中82例肠内营养患者,将其分为误吸组和非误吸组,比较两组患者的一般资料、胃管的留置深度、相关药物的使用及对其进行GCS评分,找出与误吸相关的因素。结果①两组GCS评分、护胃药物的使用、实际留置深度及胃管留置深度差值比较,差异有统计学意义(P<0.05)。②多因素Logistic回归分析结果显示,GCS评分(β=-1.137,RR=0.321,P=0.001),胃管留置深度差值(β=-0.898,RR=0.407,P=0.000)为发生误吸的独立影响因素,GCS评分越低,胃管留置深度差值越小,发生误吸的可能性越高。结论误吸后肺炎的发生严重影响重型颅脑损伤患者的预后,系统的分析误吸发生的原因和提出护理对策对减少鼻饲患者误吸发生率有明显效果。Objective To study the causes of aspiration in gastrointestinal nutrition in the patients with severe head injury and coma and their preventive nursing measures.Methods Retrospective analysis was used to select patients with severe head injury who were admitted to our department from January 2018 to June 2019,including 82 patients with enteral nutrition.They were divided into aspiration group and non-aspiration group.The general data,the depth of gastric tube indwelling,the use of related drugs and the GCS score were compared between the two groups.The factors related to aspiration was identified.Results①The GCS score,the use of gastric-protective drugs,the actual indwelling depth and the difference of gastric tube indwelling depth of two groups were statistically significant(P<0.05).②The results of multivariate Logistic regression analysis showed that the GCS score(β=-1.137,RR=0.321,P=0.001)and the difference of gastric tube indwelling depth(β=-0.898,RR=0.407,P=0.000)were independent factors influencing the occurrence of aspiration.The lower the GCS score,the smaller the difference in gastric tube indwelling depth,and the higher the possibility of aspiration.Conclusion The occurrence of pneumonia after aspiration seriously affects the prognosis of patients with severe head injury.A systematic analysis of the causes of aspiration and nursing measures have a significant effect on reducing the incidence of aspiration in the patients with nasal feeding.

关 键 词：神经外科 肠内营养 鼻饲 误吸 预防护理 

分 类 号：R473.6[医药卫生—护理学]