成人鼻胃管位置判断方法的证据总结

Evidence synthesis of determining the correct nasogastric tube placement in adult

目的:总结评价成人鼻胃管位置判断方法的最佳证据,为临床护理工作提供依据。方法:计算机检索Cochrane Library(CDSR、DARE)、Joanna Briggs(JBI)循证卫生保健国际合作中心图书馆、美国指南网(NGC)、加拿大安大略注册护士协会(RNAO)、苏格兰学院间指南网(SIGN)、Pubmed、Embase、中国生物医学文献数据库(CBM)内的指南、证据总结、推荐实践、最佳实践信息册以及系统评价。检索时间从建库至2017年7月。由2名研究者独立进行文献质量评价,对纳入的文献进行证据提取。结果:共纳入11篇文献,其中2篇指南、1篇推荐实践、1篇证据总结、1篇最佳实践信息册、6篇系统评价。最终总结了6条最佳证据,分别为(1)机械通气的病人使用二氧化碳监测法来判断鼻胃管位置;(2)非机械通气病人可采用胃管抽出物pH值结合生化检测(如胆红素、胃蛋白酶、胰蛋白酶)测定、弹簧压力计、超声检查、磁追踪系统的方法判定鼻胃管的位置;(3)X射线是确认胃管位置的金标准,但不可作常规使用;(4)检测胃管内抽出物pH值是除X射线外最可靠的方式;(5)pH值<5.5可判断鼻胃管在胃内。若无胃内容物抽出,注入10～20 ml空气,15～30 min后再抽吸一次。如仍无胃内容物抽出或pH值超过5.5,应向上级人员报告;(6)不推荐使用肉眼观察抽出物、听气过水声、石蕊试纸测试酸碱度等方法判断鼻胃管是否在胃内。结论:成人鼻胃管位置判断方法仍在更新之中,尚无统一的标准,护理人员可针对以上证据合理引用学习,结合临床情境和病人需求开展相关研究,为更新教材、制定符合我国国情的指南提供依据。

Objective: To summarize and evaluate the best available evidences of the nasogastric tube position of adults during clinical nursing. Methods: We searched through the Cochrane Library(CDSR、DARE), JBI Library,National Guideline Clearinghouse(NGC), Registered Nurses’ Association of Ontario(RNAO), Scottish Intercollegiate Guideline(SIGN), Pubmed, Embase, CBM database to collect literatures including guideline, evidence summary,recommend practice, best practice information sheet, system review from inception to July 2017. Two authors independently assessed quality of literatures and extracted data. Results: A total of 11 literatures were enrolled,including two guidelines, one recommend practice, one evidence summary, one best practice information sheet, and six system reviews. Finally, six best available evidences are summarized as followed:(1)the use of carbon dioxide detection to identification placement of nasogastric feeding tube in mechanically ventilated patients;(2)biochemical parameters(e.g. bilirubin, pepsin and trypsin), spring gauge pressure manometer, sonography and magnetic detection may be effective to determining nasogastric tubes placement in non-mechanically ventilated;(3)X ray is the gold standard for confirming the location of nasogastric tube, but not routinely recommended;(4)the pH of aspirate in the nasogastric tube can be used as a most reliable method except of X-ray;(5)pH value less than 5.5 would determine the nasogastric tube in the stomach.If no gastric contents are aspirated, injecting 10 to 20 ml of air and waiting 15 to 30 minutes and aspirate again. If no aspiration or the p H value is more than 5.5, report to medical officer;(6)visual inspection of aspirates, auscultation and acid/alkaline tests using litmus paper are not recommended to assess nasogastric tube position. Conclusion: The evidence of confirming nasogastric tube position is still being updated and there was nonunified standard. Therefore,nursing staffs can learn from the evidence reasonably, considering the specific clinical situation and the demands of the patient to do some relevant researches to updating teaching material and formulating guidelines.