胰十二指肠切除术后2种不同肠内营养途径并发症的临床观察与护理

Clinical observation and nursing for complications of two different enteral nutrition approaches after resection of pancreatic duodena

目的探讨胰十二指肠切除术后经鼻空肠肠内营养与经空肠造瘘肠内营养2种营养途径并发症发生率及相应护理措施。方法选择新疆医科大学第一附属医院胰腺外科2013年1月—2014年2月接受胰十二指肠切除术(PD术)的56例患者,其中26例术后接受经鼻空肠肠内营养(NJT组),30例给予经空肠造瘘肠内营养(JT组),记录其一般资料,比较术后肠内营养并发症发生率。结果 NJT组发生恶心、呕吐、腹胀不良反应10例(38.4%),JT组2例(6.7%),两组差异有统计学意义(P<0.05);NJT组腹泻发生率为23.1%(6例),JT组腹泻发生率为13.3%(4例),两组差异无统计学意义(P>0.05);NJT组糖代谢紊乱发生率为46.1%(12例),JT组为30.0%(9例),两组差异无统计学意义(P>0.05);NJT组管腔移位率为42.3%(11例),JT组为10%(3例),两组差异有统计学意义(P<0.05);NJT组管道阻塞率为19.2%(5例),JT组为3.3%(1例),两组差异有统计学意义(P<0.05)。结论 PD术后经空肠造瘘肠内营养并发症发生率相对经鼻空肠肠内营养低,规范化护理措施是保障肠内营养顺利完成的关键。

Objective To explore the incidence of complications and corresponding nursing measures of two kinds of nutrition ways after pancreaticoduodenal resection.Methods Select 56 cases treated with resection of pancreas duodenum in Pancreatic Surgery Department from the First Affiliated Hospital of Xinjiang Medical University in2013.1-2014.2,among whom,26 cases with nasal jejunum enteral nutrition（NJT）,30 cases with Jejunum colostomy enteral nutrition（JT）.Compare the complication rate of postoperative enteral nutrition.Results There were 10 cases of nausea,vomiting,abdominal distension in NJT（38.4%）,2 cases in JT（6.7%）,with statistically significant difference（P〈0.05）; The incidence of diarrhea in NJT group was 23.1%（6 cases）,13.3%（4cases） in JT group,without statistically significant difference（P〈0.05）; The incidence of sugar metabolic disorder in NJT group was 46.1%（12 cases）,30.0%（9 cases） in JT group,without statistically significant difference（P〉0.05）; the rate of lumen shift in NJT group was 42.3%（11 cases）,10%（3 cases） in JT group（P〈0.05）; the rate of nutrition tube obstruction in NJT group was 19.2%（5 cases）,3.3%（1 case） in JT group（P〈0.05）.Conclusion Postoperative complication rate of the jejunum colostomy enteral nutrition was relatively lower than that in nasal jejunum enteral nutrition.Standardized nursing was the key to the effective enteral nutrition.