床边幽门后喂养管置管法用于重症患者的初步研究

A pilot study of a novel method for bedside placement of postpyloric feeding tubes in critically ill patients

目的观察床边徒手幽门后喂养管置管法对重症患者治疗的效果，并对置管成功率、操作时间及安全性进行评价。方法2009年2月至7月对需幽门后喂养者实施幽门后喂养管置管。使用130cm长、带导丝的普通鼻胃肠管，操作前静脉给予10mg甲氧氯普胺。置管过程中依气过水声、真空试验、回抽液pH值以及导丝来综合判断导管位置。开始肠内营养前拍腹部X线平片证实导管头端位置。记录置管时间、成功率、从决定肠内营养到开始喂养的时间以及并发症的发生情况。结果入选28例患者，主要适应证为：有误吸高风险者18例，胃瘫3例，急性胰腺炎7例。28例患者幽门后置管成功26例，成功率为92．9％；其中21例（占75．0％）到达空肠近段；平均置管时间（20．36±6．41）min；从决定肠内营养到开始喂养时间（4．15±1．68）h。无严重并发症发生。结论使用普通带导丝鼻胃肠管床边幽门后喂养管置管，一人即可完成操作，是一种安全、简便、性价比高的喂养管置管方法。

Objective To investigate a novel method of bedside placement of postpyloric feeding tubes in critically ill patients, and to evaluate its success rate, time used, and safety of this bedside method. Methods Data of consecutive patients requiring postpyloric feeding from February 2009 to July 2009 were collected. In this new method, a nonweighted 130-cm-long nasoenteric feeding tube with a guide wire was used under 10 mg of intravenous metoclopramide. The tube was gradually advanced, and the position of the tube was confirmed by auscultation to detect bubbling sound and respiration of inflated air （the vacuum test）, as well as pH measurement of aspirated fluid. An abdominal radiograph was made finally for confirmation of the position of the tube before the feeding was initiated. The time taken to insert the tube, the success rate, the time between the decision to feed and commencement of feeding, and the complications of the procedure were recorded. Results In 28 patients the postpyloric feeding tube was placed. The main indication was 18 cases with high risk of aspiration, 3 with gastroparesis, and 7 with acute pancreatitis. Of the 28 tube placements performed, 26 （92.9~） were successful, and in 21 （75.00/6o of 28） the tube was in the jejunum. The average time for successful placement was （20.36±6.41） minutes. The time between the decision for feeding and commencement of feeding was （4. 15±1.68） hours. No Complications occurred. Conclusion Using a conventional nasoenteric feeding tube with a guide wire, and only one medical staff needed for the placement of the tube, this method is an efficient and cost-effective method of bedside postpyloric feeding tube placement.