长期卧床老年肿瘤患者鼻饲体位与反流、误吸发生的关系

Relationship of nasal feeding postures and aspiration in elderly patients with tumor

目的观察鼻饲时适当抬高床头角度预防误吸、反流的效果。方法长期卧床老年肿瘤患者44例,每日三餐鼻饲,分别采取床头抬高15-30度(低角度组)和45-60度(高角度组)下鼻饲15d。每餐进食量200ml,进食时间15-20min。比较不同角度鼻饲时期患者反流、误吸发生情况,持续监测食管pH值。结果高角度组呛咳和呕吐发生率均低于低角度组(2.37%vs.0.61%和(1.92%vs.0.56%)(P<0.05)。低角度体位鼻饲患者食管pH<4的次数和pH<4持时>5min的次数均高于高角度组[(11.67±1.52)次vs.(7.45±1.24)次和(5.13±1.12)次vs.(3.32±1.07)次](P<0.05);低角度组食管pH<4持续最长时间长于高角度组[(12.29±4.52)min vs.(7.42±2.11)min](P<0.05)。结论采取在床头抬高45-60度下鼻饲能有效减少食物反流和误吸的发生。

Objective To observe the effect of elevating bedhead degrees during nasal feeding on the incidence of aspiration in the elderly with tumor. Methods Forty-four bedridden elder patients with tumor were given nasal feeding under two bedhead positions of A（with head up 15-30 degrees for 15 days） and B（with head up 45-60 degrees for 15 days）. The nasal feeding with liquid food 200 ml was performed in 15-20 min for three times a day. The incidence of reflux and aspiration were observed. The changes of esophageal pH value were recorded and compared between two groups as well. Results The incidence rates of choking cough and vomiting were significantly higher in group A than those in group B（2.37% vs. 0.61% and （1.92% vs. 0.56%）（P〈0.05）. The times of esophageal pH%4 and esophageal pH〈4 lasted for more than 5 min were more in group A than those in group B[（11. 67±1.52） times vs. （7.45±1.24） times and （5.13±1.12） vs. （3.32±1.07） times （P〈0. 05）. The longest time for esophageal pH〈4 to last was longer in group A than that in group B [（12.29± 4. 52） min vs. （7.42 ±2.11） mini（P〈0. 05）. Conclusion Nasal feeding under head up 45-60 degrees can effectively reduce the incidence of food regurgitation and aspiration in bedridden and elderly patients with tumor.