经胃持续肠内营养的重症脑卒中患者翻身时床头抬高最佳角度的研究  

Study on the optimal angle of the head of the bed raised during turning over for patients with severe stroke receiving transgastric continuous enteral nutrition

作　　者：臧丽丽 宗晶 王佀慧 唐亚男 石素宁 张莹 Zang Lili;Zong Jing;Wang Sihui;Tang Yanan;Shi Suning;Zhang Ying(Department of Neurology,the 96Oth Hospital of the Joint Logistic Support Force of the Chinese People's Liberation Army,Jinan 250031,China;Department of Nursing,the 960th Hospital of the Joint Logistic Support Force of the Chinese People's Liberation Army,Jinan 250031,China)

机构地区：[1]中国人民解放军联勤保障部队第九六〇医院神经内科,济南250031 [2]中国人民解放军联勤保障部队第九六〇医院护理部,济南250031

出　　处：《中国实用护理杂志》2024年第21期1608-1614,共7页Chinese Journal of Practical Nursing

基　　金：中国人民解放军联勤保障部队第九六○医院青年自主创新科学基金(2023HL01)

摘　　要：目的探讨经胃持续肠内营养重症脑卒中患者翻身时床头抬高的最佳角度,为临床肠内营养安全输注提供依据。方法采用前瞻性研究及重复测量方法。便利抽样法选取2023年1—10月入住中国人民解放军联勤保障部队第九六〇医院神经内科监护室行持续肠内营养的重症脑卒中患者154例作为研究对象,超声下观察研究对象翻身时床头角度在30°、20°、10°、0°时5 min内贲门反流次数、反流时间,统计患者观察期间反流发生率、误吸发生率。结果最终纳入患者148例。其中男81例,女67例,年龄38~80(65.79±10.96)岁。患者经胃持续肠内营养患者翻身时床头抬高角度10°贲门反流发生率[18.24%(27/148)]、误吸发生率[4.05%(6/148)]与抬高20°的贲门反流发生率[12.16%(18/148)]、误吸发生率[1.35%(2/148)]比较差异均无统计学意义(均P>0.05);床头抬高10°和20°分别与床头抬高0°的贲门反流发生率[37.16%(55/148)]、误吸发生率[10.81%(16/148)]比较差异均有统计学意义(χ^(2)值为4.91~24.89,均P<0.05)。结论持续肠内营养的重症脑卒中患者翻身时床头抬高10°时既可以预防胃内容物反流引起的误吸,又符合翻身时节力原则,是持续肠内营养的神经重症患者推荐的翻身角度。Objective To investigate the optimal angle of bedhead elevation during logrolling of patients with severe stroke supported by continuous enteral nutrition via gastric tube administration,and to provide a basis for safe infusion of enteral nutrition in clinical practice.Methods This study was a prospective study,and the repeated measurement method was used.A total of 154 patients with severe stroke who were admitted to the Neurology Intensive Care Unit of the the 960th Hospital of the Joint Logistic Support Force of the Chinese People′s Liberation Army and treated with continuous enteral nutrition support from January to October 2023 were selected as the study participants by convenience sampling method.The times and duration of cardia reflux in 5 min were observed under ultrasound when the bedhead elevation angle during logrolling of the study participants was 30°,20°,10°,and 0°,respectively,and the incidence of reflux and aspiration during the observation period were recorded.Results A total of 148 patients were eventually included.Among them,81 were males and 67 were females,aged 38-80(65.79±10.96)years.There were no significant differences in the incidence of reflux[18.24%(27/148)vs.12.16%(18/148)]and aspiration[4.05%(6/148)vs.1.35%(2/148)]when the angle of bedhead elevation during logrolling of patients with continuous enteral nutrition via gastric tube administration was 10°and 20°(all P>0.05).Nevertheless,compared with the incidence of reflux[37.16%(55/148)]and aspiration[10.81%(16/148)]at the bedhead elevation angle of 0°,those measured at 10°or 20°were significantly different(χ^(2) values were 4.91-24.89,all P<0.05).Conclusions For patients with severe stroke supported by continuous enteral nutrition,bedhead elevation angle of 10°can not only prevent aspiration caused by gastric reflux,but also conform to the labor-saving principle during logrolling,which is the recommended angle of logrolling for patients with severe neurological diseases supported by continuous enteral nutrition.

关 键 词：体位 护理 肠道营养 卒中 危重症 

分 类 号：R473.74[医药卫生—护理学]