住院留置胃管新生儿非计划性胃管拔除的前瞻性研究

Prospective study of unplanned extubation of neonatal with gastric tube

目的对新生儿非计划性胃管拔除（UEX）的发生现状进行前瞻性研究，探讨其发生原因，分析对策。方法对我院716例新生儿病房留置胃管的患儿进行登记观察，非计划性拔管者进行登记，包括插管时间、目的，拔管时间、原因等因素，对胃管UEX影响因素进行统计分析。结果在研究期间留置胃管的新生儿中，UEX发生95例（13．3％），1．54次/100个置管日；经口咽插管途径置管[33．6％（46／137）]、肢体无约束[24．3％（42／173）]情况下胃管脱落率高于经鼻咽[18．5％（49／579）]及有肢体约束[9．8％（53／543）]，差异有统计学意义（P值分别为0．046，0．004）；胶带固定脱落率[18．1％（23／127）]高于透明辅料11．4％（41／359）及绷带固定9．4％（31／330），差异有统计学意义（P=0．034）；由于医护人员操作过程中发生UEX为24．2％（23／95）；UEX高发于中午（12：00-14：00）及午夜（22：00-01：00）；UEX的影响因素包括置管途径（口腔与鼻咽，P=0．031，RR=1．563，95％CI 1．205～2．341）、胃管的固定方式（胶带与透明辅料及绷带，P=0．004，RR：1．492，95％CI1．320～3．541）肢体约束（有／无，P=0．021，RR=1．298，95％C11．087～3．271）。结论选择鼻腔入路、进行有效的肢体约束及固定，完善巡视制度，规范操作流程是预防新生儿胃管UEX的有效策略。

Objective To analyze the cause of neonatal unplanned extubation（UEX） of gastric tube as well as explore the strategies. Methods Seven hundred and sixteen neonates with gastric tube were registered. Their intubation time, intubation aim, extubation time, extubation reasons of unplanned extubation of gastric tube were recorded and analyzed. Results The incidence of UEX of gastric tube was 13.3% （95 cases） and 1.54 per 100 tube days in the neonates. The incidences of UEX in channel orally and body unrestraint were 33.6% （46/137） and 24. 3% （42/173） ,higher than that of nasopharyngeal tube（18.5%（49/579） ） and body restraint（9. 8% （ 53/543 ） ）, and the difference was significant （ P = 0. 046,0. 004 ）. Incidence of UEX in adhesive tape fixing group was 18. 1% （23/127）, higher than in bandage group （11.4% （41/359）） and transparent dressing group（9.4% （31/330）） ,and the difference was significant（P =0. 034）. Incidence of UEX caused by doctors or nurses was 24. 2% （23/95）. There were more UEX from 12 to 14 O＇clock and 22 to 1 O＇ clock. The channel of gastric tube （ Oral cavity and nasopharynx, P = 0. 031, RR = 1. 563,95% CI 1. 205 - 2. 341 ）, fixing method of tube （ tape, bandage and transparent dressing, P = 0. 004, RR = 1. 492,95 % CI 1. 320 - 3. 541 ） and body restraint （ had/hadn＇t, P = 0. 021, RR = 1. 298,95 % CI 1. 087 - 3.271 ） were the influence factors of UEX. Conclusion The approaches including selecting nasal cavity as the tube channel, effective fixing of the tube, proper body restraint, perfect wandering round and standard nursing practicing are effective strategies to prevent UEX of gastric tube.