电磁定位导航仪指导鼻空肠营养管置管的临床探索

A new method of placement of naso-jejunum feeding tube guided by electromagnetic positioning navigator

目的探讨床旁经电磁定位导航仪引导下行鼻空肠营养管置管技术在危重症患者早期肠内营养中的应用价值。方法床旁在电磁定位导航仪监视下,利用手法将带有电磁接收器内导丝的营养管自鼻腔经胃、十二指肠,置入Treitz韧带远端,随后行床旁腹部平片确认营养管位置。同时观察操作过程中患者不良反应及并发症的发生情况。结果共纳入15例危重症患者,年龄21~72（50.9±15.8）岁;置管时患者APACHEⅡ评分6~35（18.6±7.8）分,其中机械通气患者10例,需血管活性药物者5例,孕妇1例。所有患者均成功置管,成功率为100%,置管时间为5~42（均值20.2）min;随后行腹部X线证实全部营养管位置与导航仪显示吻合,孕妇经腹部超声证实放置成功。操作过程中3例因导管刺激出现恶心,其余所有患者均无明显不良反应。结论经电磁定位导航仪引导下放置鼻空肠营养管,是一种操作简单、安全可靠的置管技术,成功率高,为危重症患者早期肠内营养支持提供了更为安全有效的途径。

Objective To study the clinical application of electromagnetic positioning navigator assisted placement ofnaso- jejunal feeding tube in early enteral nutrition for patients with critical illness. Methods Critically ill patients, who showed very high risks and could not withstand transferring for tube placement were selected as study subjects. The feeding tube with affiliated wire was inserted to jejunum guided by electromagnetic positioning navigator, and the site was confirmed by abdominal X-ray film or bedside ultrasound. The patients＇ vital signs, side effects and complications during and after the procedure were observed. Results Fifteen critically ill patients, aged 21-72 （mean 50.9 ± 15.8） and with APACHE 11 scores of 6-35 （mean 18.6 ± 7.8）, underwent this procedure. Of them 10 were undergoing mechanical ventilation, and 5 were given drugs to raise blood pressure. All the placement of feeding tubes were successfully. The intubation time was 5-42 minutes （mean 20.2min）. Vital signs of all the patients were stable during the procedure, except for nausea 3 patients. No severe complications occurred. Conclusion The placement ofnaso-jejunal feeding tube guided by electromagnetic positioning navigator is easy to operate, safe and with high success rate, so it offers an effective route for early enteral nutrition for patients with critical illnesses.