重症患者双导丝盲视法置鼻肠管肠内营养临床可行性研究

Double guidewire method for bedside blind placement of gastrointestinal feeding tubes for critical patients

目的评价双导丝盲视法置鼻肠管在重症患者肠内营养(enteral nutrition,EN)中的应用安全性及可行性。方法在100例重症患者中,分别采用盲视法将双导丝+甲氧氯普胺(A组)50例和单导丝+甲氧氯普胺(B组),50例由CORFLO胃肠营养管经胃通过幽门推送至空肠,立即进行腹部X线明确管端位置。监测患者置管前、中、后1h心率(HR)、呼吸(RR)、平均动脉压(MAP)、血氧饱和度(SpO2)的变化,对置管时间、置管并发症及置管成功率进行统计学分析。结果双导丝与单导丝置管成功率分别为92.0%、80.0%;平均置管时间为(19.12±5.97)min、(20.88±4.89)min;两组比较,双导丝成功率较单导丝高,差异有统计学意义(P<0.05)。置管中患者重要生命体征无明显变化,未发生严重置管并发症。结论双导丝盲视法置胃肠营养管较单导丝置管成功率高,具有简单易行、安全、侵袭性小,对设备无特殊要求的特点,可作为重症患者EN支持治疗的有效途径之一。

Objective To evaluate safety and feasibility of bedside blind placement of gastrointestinal feeding tubes by double guidewire method applied to critical patients enteral nutrition in ICU. Methods In 100 cases of critically ill patients, by the double guidewire and single guidewire method for bedside blind placement of gastrointestinal feeding tubes through the stomach pass the pylorus, continue to push to the jejunum, immediately to make clear tube end position by abdominal X-ray. Monitoring the changes in patient built-in tube before, during and after lh heart rate （HR）, respiratory （RR）, mean arterial pressure （MAP）, blood oxygen saturation （SpO2）, and analyze the time of built-in tube, success rate and complications of built-in tube. Results Double guidewire and single guidewire success rates are 92% and 80% of built-in tube; the time of built-in tube was （ 19. 12 ± 5.97） min and （20.88 ± 4.89） rain; No changes of important vital signs and complications occurred in process of built-in tube. Conclusion Double guidewire method for bedside blind placement of gastrointestinal feeding tubes with a simple, safe, small invasive, and requires no special equipment features, can be one of the effective ways to support severe patients with EN treatment.