鼻饲体位与方式对创伤昏迷病人胃内容物反流及误吸的影响

Influence of different body positions and various ways of nasal feeding on backstreaming and aspiration of gastric contents in traumatic coma patients

[目的]探讨不同鼻饲体位与方式对创伤后昏迷病人鼻饲后胃内容物反流及误吸的影响。[方法]采用正交试验设计,27例创伤后昏迷病人在不同床头高度、卧位、鼻饲速度及鼻饲量条件下,鼻饲含放射性锝的匀浆液,收集鼻饲后1h、2h、3h、4h及5h病人口咽及支气管的分泌物,测定其中的放射性计数。[结果]在不同床头高度鼻饲后1h、3h,不同卧位鼻饲后2h,不同鼻饲速度鼻饲后1h、2h,病人口咽分泌物的放射性计数差异有统计学意义;在不同床头高度鼻饲后1h、2h,不同鼻饲速度鼻饲后2h,病人支气管分泌物的放射性计数差异有统计学意义。[结论]床头抬高30度或45度、左侧卧位及鼻饲速度为10mL/min时胃内容物反流或误吸较少,而不同鼻饲量对口咽反流及误吸无明显影响。

Objective： To probe into the effect of different body positions and methods of nasal feeding on backstreaming and aspiration of gastric contents in traumatic coma patients. Method： By adopting orthogonal design, a total of 27 traumatic coma patients were fed with homogenate containing radioactive technetium via nasal, in different heights of headstocks, different recumbent position, various speeds and different quantities of nasal feeding. Excretions of oropharynx and bronchial of patients were collected 1 h,2 h,3 h,4 h and 5 h after nasal feeding and radioactive technetium among which were counted respectively. Result： There were significant differences in terms of radioactive technetium counting among oropharynx excretions of patients in different height of bedsides 1 h and 3 h after nasal feeding, in different incumbent positions 2 h after feeding, and in various speeds of nasal feeding 1 h and 2 h after feeding. There were significant differences in terms of radioactive technetium containing of bronchial excretion of patients in different heights of bedsides 1 h or 2 h after nasal feeding, and in various speeds of nasal feeding 2 h after the feeding. Conclusion： It showed that the quantity of oropharynx backstreaming and aspiration are the lowest when pa- tients were lying in beds with bedsides lifted 30 or 45 degree, patients were in left recumbent position and nasal feeding speed were at 10 mL/min. However, different quantities of nasal feeding for patients had no obvious influence on oropharynx backstreaming and aspiration of them.