床旁空肠营养管徒手置入技术在危重症病人营养治疗中的应用研究

A research on beside manual placement of jejunal feeding tube for nutritional therapy of critically ill patients

目的:探讨床旁空肠营养管徒手置入技术在危重症病人肠内营养(EN)治疗中的安全性、有效性和实用性。方法:鼻空肠管组病人采用美国CORPAK公司CORFLO导管置入行鼻空肠营养29例。鼻胃管组采用普通胃管置入行EN支持30例。观察鼻空肠管组置管成功率,置管时间和不良反应。对比观察两组病人血清清蛋白(ALB)、前清蛋白(PA)、血红蛋白(Hb)、APACHEⅡ评分、入住ICU时间、置管费用和ICU总费用等指标的变化,以及反流、腹胀、腹泻、应激性溃疡和吸入性肺炎等并发症的发生率。结果:床旁经鼻空肠营养管徒手置入成功率为93.1%,置管时间为(19.3±6.8)min,无不良反应。鼻空肠管组病人营养指标和APACHEⅡ评分改善明显,且入住ICU时间、ICU总费用和并发症的发生率均低于对照组。结论:床旁空肠营养管徒手置入技术在危重症病人EN支持治疗中,具有操作简单、安全、置管成功率高、并发症低、病人营养状况改善明显的优点。

Objective： To explore the safety, effectiveness and practicality of beside manual placement of jejunal feeding tube for nutritional therapy among critically ill patients. Methods： 29 patients were placed with nasojejunal feeding tube manually at bedside. 30 patients with nasogastric feed- ing tube were as control group. The success ratio, duration and adverse reaction of tube placement were observed. Meanwhile, albumin （ALB）, prealbumin （PA）, hemoglobin （Hb）, APACHE Ⅱ score, medium ICU stays, tube placement expense, total expense and incidence rate of reflux, abdominal distension, diarrhoea, stress ulcer and aspiration pneumonia were observed in the two groups. Results ： The success ratio of beside manual placement through nasojejunal feeding tube was 93.1% and placement duration was （ 19.3 ± 6.8 ） min with no adverse reaction. Nutritional indexes and APACHE I1 score were significantly improved in research group. Besides, the length of ICU stays, total expense and inci- dence rate of complication in research group were all lower than those in control group. Conclusion ： In criticalpatients＂ nutrition support therapy, beside manual placement of jejunal feeding tube is simple to operate, safe, effective and practicable.