重症患者床旁放置鼻肠营养管的应用分析

Application of Bedside Placement of Nasoenteric Tube in Critically Ill Patients

目的探讨重症患者床旁放置鼻肠营养管(简称鼻肠管)的安全性和可行性。方法对19例重症患者常规给予甲氧氯普胺10 mg,10 min后采用床旁间断直线推进法放置鼻肠管,30 min仍未顺利通过幽门置入则采用被动等待法,前者即刻、后者24 h后床旁行X线腹部拍片明确。观察19例患者的置管时间、方式,置管成功率及并发症发生率。结果 19例患者中17例在床旁间断直线推进法置管成功,成功率为84%。置管时间(22.4±3.9)min,X线摄片间接判断鼻肠管端位于十二指肠降部1例、水平部4例、升部10例,空肠上段2例。2例间断直线推进法未成功,采取被动等待法均置管成功,X线摄片提示管端均位于十二指肠升部。所有患者鼻肠管平均放置时间为(38±42)d,无严重并发症发生。结论重症患者间断直线推进法床旁放置鼻肠管是安全可行的,被动等待法可作为补救置管措施。

Objective To investigate the safety and feasibility of bedside placement of nasoenteric tube in critically ill patients. Methods Nineteen critically ill patients received the placement of nasoenteric tubes through intermittent straight line insertion after treatment with 10 mg metoclopramide for 10 minutes. The passive waiting method was used if nasoenteric tubes were not passed through the pylorus for 30 minutes. Abdominal X-ray examination was performed immediately after insertion in patients undergoing intermittent straight line insertion and 24 hours after insertion in patients undergoing passive waiting insertion to confirm the successful placement of nasoenteric tubes. 19 cases of catheterization time, catheterization method,successful rate and complications were recorded. Results Among the 19 patients,17 （84%） underwent successful placement of nasoenteric tubes through intermittent straight line insertion with an average catheterization time of （ 22 . 4 ± 3 . 9 ） minutes . X-ray examination showed that the tip of nasoenteric tube was located at descending duodenum in 1 patient,horizontal duodenum in 4 patients,ascending duodenum in 10 patients and upper jejunum in 2 patients. Intermittent straight line insertion was failed but the placement of nasoenteric tubes by using passive waiting method was successfully performed in 2 patients. X-ray examination showed that the tip of nasoenteric tube was located at ascending duodenum in these two patients. The average duration of catheterization was （38 ±42） days and no serious complications occurred in all patients. Conclusion Bedside placement of nasoenteric tubes through intermittent straight line insertion is a safe and feasible method for critically ill patients. The passive waiting method may be used as a remedial measure.