鼻胃管对医院获得性鼻窦炎影响的临床研究

CLINICAL STUDY ON THE EFFECT OF NASOGASTRIC TUBE ON THE NOSOCOMIAL SINUSITIS

[目的]探讨鼻胃管对医院获得性鼻窦炎患病率的影响。[方法]江苏省苏北人民医院重症医学科(ICU)2006年1月～2006年12月保留鼻胃管的患者纳入研究,纳入前均行鼻窦CT检查,排除鼻窦炎。鼻胃管留置时间少于5d的患者予以剔除。研究分两个阶段。第1阶段,患者鼻胃管在留置7～14d后拔除或更换到对侧鼻孔留置。第2阶段,患者鼻胃管在留置5～7d后拔除或更换到对侧鼻孔留置。更换前检查鼻窦CT,记录拔除鼻胃管时两组患者医院获得性鼻窦炎患病率和住院期间医院获得性肺炎患病率,记录患者ICU住院时间和总住院时间。[结果]共有76例患者入选,其中第1阶段36例(A组),第2阶段40例(B组)。两组患者年龄、性别和急性生理学与慢性健康状况评分Ⅱ评分等一般情况无统计学差异(P﹤0.05)。A组平均更换鼻胃管时间为(9.8±1.7)d,B组为(6.6±0.7)d,较A组明显缩短(P﹤0.01)。A组鼻窦炎患病率明显高于B组(83%对20%,P﹤0.01),但两组患者医院获得性肺炎患病率分别为44%和30%,无明显统计学差异(P﹥0.05)。A组患者ICU住院时间为(21±9)d,总住院时间为(25±10)d,与B组患者ICU住院时间(14.6±2.3)d和总住院时间(21±4)d相比,无明显统计学差异(P﹥0.05)。[结论]定期在留置7d内更换鼻胃管可明显降低医院获得性鼻窦炎患病率。

[Objective] To observe the effect of nasogastric tube on the morbidity of nosoconfial sinusitis. [Methods] From January 2006 to december 2003, patients in ICU with nasogastric tube were recruited in this study, however, patients were examined with CT to exclude the patients with naso sinusitis before recruiting. People should keep the nasogastric tube more than 5 days. The study was divided two phases, primary phase, nasogastric tube was replaced or to another nostril after 7 to 14 days. Second phase, nasogastric tube was replaced or another nostril after 5 to 7 days. CT scan were examined before change the nasogastric tube. recorded the morbidity of nosocomial sinusitis and pneumonia, the duration of patients stay at ICU and hospital. [ Results ] 76 patients were involved the study, among them 36 patients were in primary phase （A group）, another patients were in second phase （B group ）. The two groups showed no significant difference at age, sex, and APACHE Ⅱ score. The duration of replace nasogastric tube to another nostril was 9.8±1.7 days in A group and 6.6±0.7 days in B group （P〈 0.05）. The morbidity of nosoeomial sinusitis was significant higher in A group than in B group （83% vs 20%. P〈 0.01 ）, there was no significant difference in nosocomial pneumonia （44% vs 30%, P 〉 0.05）. In A group the length of patients was 21±9 days in ICU, and 25±10 days in hospital, in B group the duration were 14.6±2.3 days and 21 ±4 days （P〉 0.05）. [Conclusion] Replace nasogastrie tube less than 7 days could significant decrease the morbidity of nosocomial sinusitis.