应用鼻胃管盲插空肠置管在机械通气患者中的效果  

Study on effect of using blind insertion of nasogastric tube to perform jejuum catheterization in patients with mechanical ventilation

作　　者：蒋玉兰 谌绍林 谢立琴 代有华 李思思 Jiang Yulan;Chen Shaolin;Xie Liqin;Dai Youhua;Li Sisi(Department of Critical Care Medicine,First Affiliated Hospital of Hunan University of Medicine,Huaihua 418000,Hunan,China;Department of Nursing,Affiliated Hospital of Zunyi Medical University,Zunyi 563000,Guizhou,China)

机构地区：[1]湖南医药学院第一附属医院重症医学科,湖南怀化418000 [2]遵义医科大学附属医院护理部,贵州遵义563000

出　　处：《中国中西医结合急救杂志》2022年第2期198-201,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：湖南省教育厅科研项目(19C1336)。

摘　　要：目的观察主动推进法盲插鼻胃管与鼻空肠管在重症监护病房(ICU)机械通气患者中行空肠置管的效果。方法选择2019年4月至2020年3月在湖南医药学院第一附属医院ICU住院治疗的176例机械通气且需肠内营养支持的患者作为研究对象。按置管类型将患者分为对照组和观察组,每组88例。两组均采用主动推进法盲插空肠置管。对照组和观察组分别用螺旋型鼻空肠管和复尔凯鼻胃管行空肠置管。比较两组患者咽喉部一次性通过率、一次性肠内置管成功率、一次性置管成功者的导管尖端位置、置管用时、置管费用、置管相关并发症和医护人员置管相关感受的差异。结果观察组咽喉部一次性通过率明显高于对照组〔90.91%(80/88)比70.45%(62/88),P<0.05〕。观察组和对照组患者一次性肠内置管成功率及导管尖端位置比较差异无统计学意义;观察组胃内置入用时、置管总用时均较对照组明显缩短〔胃内置入用时(min):2.98±1.51比5.41±4.96,置管总用时(min):26.42±2.36比29.30±5.32,均P<0.01〕,置管费用较对照组明显降低(189元/例比422元/例,P<0.05);两组在置管过程中均未出现咽喉部损伤、误吸、低血压、呼吸机相关性肺炎(VAP)等置管并发症。对操作护士调查,均表示鼻胃管操作简单方便,更愿采用复尔凯鼻胃管置管。结论机械通气患者可用鼻胃管代替鼻空肠管通过主动推进法盲插空肠置管,操作简单,更易通过咽喉部,置管有效、安全、经济,易于在临床普及推广。Objective To observe the effects of jejunum tube placement with active propulsion blind insertion of nasogastric tube or nasojejunum intestinal tube in patients with mechanical ventilation in intensive care unit(ICU).Methods A total of 176 patients who were mechanically ventilated and required enteral nutrition support,and hospitalized in the ICU of the First Affiliated Hospital of Hunan Medical College from April 2019 to March 2020 were selected as study subjects.The patients were divided into a control group and an observation group according to the type of catheterization,with 88 cases in each group.The placement of jejunum tube was using blind propulsion insertion method in both groups.The control group and observation group were subjected to jejunum tube placement with a spiral nasojejunal intestinal tube and a Fulcrum nasogastric tube,respectively.The differences in success rate of passing throat in the first attempt,the success rate of one-time tube placement into the intestine,the position of the catheter tip in the successful one-time tube placement,the time spent for tube placement,the cost of tube placement,the complications related to tube placement and the medical staff feelings related to tube placement were compared between the two groups.Results The success rate of passing throat in the first attempt in the observation group was significantly higher than that in the control group[90.91%(80/88)vs.70.45%(62/88),P<0.05].There were no statistical significant differences between the two groups in the success rate of the first attempt of intestinal tube placement and the position of the catheter tip in the intestine;the time in the gastric intubation,total intubation time and tube fee in the observation group were significantly lower than those in the control group[time in the gastric intubation(minutes):2.98±1.51 vs.5.41±4.96,total intubation time(minutes):26.42±2.36 vs.29.30±5.32,both P<0.05],and the cost of intubation was significantly lower than that of the control group(yuan:189 per case vs.422

关 键 词：鼻胃管 鼻空肠管 主动推进法 机械通气 盲插 

分 类 号：R47[医药卫生—护理学]