2092例肠内营养置管方法分析

Gastrointestinal tract access of enteral nutrition in 2 092 patients

目的比较不同肠内营养置管方法的优缺点。方法1996年9月-2008年6月，共有2092例患者接受肠内营养支持。肠内营养置管方法包括床旁经鼻置螺旋型鼻肠管、X线引导下经鼻置鼻肠管、胃镜引导下经鼻置鼻肠管、术中经鼻置鼻肠管、空肠切开造口置空肠管、空肠穿刺造口置空肠管、胃切开造口术及内镜引导下经皮胃穿刺造口术。结果床旁经鼻置肠管32例，第2天23例鼻肠管的远端通过幽门到达小肠，另9例鼻肠管盘曲在胃腔内。X线引导下直接经鼻置鼻肠管61例，顺利通过幽门57例，另4例鼻肠管盘曲胃腔内。胃镜引导下经鼻置鼻肠管186例，术后经x线检查显示177例鼻肠管的远端位于小肠。腹部手术时，经鼻放置鼻肠管1628例，7例鼻肠管远端离开手术时放置的位置。空肠切开术放置空肠营养管56例，术后出现不全性肠梗阻2例、肠瘘1例。空肠穿刺造口术98例，2例空肠穿刺管移位脱出小肠。传统胃切开造口术19例，出现胃瘘1例。胃穿刺造口术12例，无并发症。结论肠内营养置管的方法有多种，具体采取哪种方法，需根据患者的原发病以及营养支持的时间决定。经鼻置鼻肠管是一种安全、简便、实用的方法。经皮穿刺胃造口术、空肠穿刺造口术将逐步替代传统的造口方法。

Objective To explore the effectiveness and safety of different enteral feeding access and feeding tube placement methods. Methods From September 1996 to June 2008, 2 092 patients were identified to undergo feeding tube placement for nutrition support. Feeding tube placement included bedside nasoenteral tube insertion, nasoenteral tube insertion under the guide of X-ray, nasoenteral tube insertion under the guide of endo- scope, intraoperative nasoenteral tube insertion, feeding jejunostomy, needle catheter jejunostomy, open feeding gastrostomy, and percutaneous endoscopic gastrostomy. Results The success rate of feeding tube placement was 71.9% （23/32） in nasoenteral tube group, 93.4% （57/61） in X ray-guided group, 95.2% （177/186） in en- doscope group, 99.6% （1 621/1 628） in abdominal operative group, 94. 6% （53/56） in open feeding jejunostomy group, 98.0% （96/98） in needle catheter jejunostomy group, 94. 7% （18/19） in open gastrostomy group, and 100% in pereutaneous endoscopic gastrostomy group. Procedure-related complications included 2 intestinal ob- structions and one intestinal fistula in open jejunostomy group, feeding tube shift-out from the intestine in 2 patients in needle catheter jejunostomy and fistula of stomach in one patient in open gastrostomy group. Conclusions The selection of access of enteral nutrition depends on the primary diseases and duration of nutrition support. Nasoenteral tube placement is safe and effective. Percutancous endoscopic gastrostomy and needle catheter jejunostomy are the alternative approaches.