脑卒中患者胃管留置不同长度的效果

Effects of gastric tube indwelling with different lengths in patients with stroke

目的：观察脑卒中患者胃管留置不同长度的应用效果,以寻求脑卒中患者胃管留置最佳长度。方法将我院182例经鼻胃管肠内营养的脑卒中患者分为对照组（ n=58）、观察A组（ n=60）和观察B组（n=64）,对照组胃管留置长度为鼻尖经耳垂至胸骨剑突的体表距离（45～55 cm）,观察A组为鼻尖经耳垂至胸骨剑突的体表距离再延长15 cm （60～70 cm ）,观察B组为患者眉心至脐的体表距离（55～65 cm）,比较3组患者胃管置入胃内的情况、反流、呛咳及误吸的发生率和胃内残留量监测情况。结果对照组53例（91.38%）胃管末端在贲门部,观察A组44例（73.33%）胃管末端在幽门部,观察B组55例（85.94%）胃管末端在胃体部；观察A组、观察 B组反流、呛咳及误吸发生率均低于对照组（P〈0.01）,监测胃内残留量大于对照组（P〈0.01）；观察A组、观察B组胃内残留量监测和反流、呛咳及误吸发生率差异无统计学意义（P〉0.05）,但观察A组有8例（13.33%）胃管在胃内扭曲或打结,2例（3.33%）进入十二指肠。结论以患者眉心至脐的体表距离（55～65 cm）留置胃管,方法简捷,对于不同身高群体的脑卒中患者更为科学合理,值得在临床实践工作中推荐。

Objective To explore the gastric tube indwelling with different length, in order to find out the best length for stroke patients. Methods A total of 182 stroke patients with enteral nutrition by nasogastric tube were randomly assigned into control group （n=58）, observation group A （n=60） and observation group B（n=64）. The indwelling length of nasogastric tube was from eyebrows to earlap then mucronate cartilage in the control group （45-55 cm）; based on this length, additional 15 cm was extended in observation group A （60-70 cm）;the length for observation group B was 55-65 cm from eyebrows to navel. The situation of gastric tube inserting, the incidence of regurgitation, bucking and aspiration and the residual gastric volume in three groups were compared. Results A total of 53 cases （91. 38%） of the control group had gastric tube ends at the cardia;in the observation group, 44 cases （73. 33%） of group A had gastric tube ended at the pylorus, and 55 cases （85. 94%） of observation group B in the body of the stomach. The incidence of regurgitation, bucking and aspiration in observation group A and group B were both significant lower than those of the control group （P〈0.01）, but the residual gastric volumes in two groups were more than that of the control group （P 〈0. 01）;there were no significant differences between group A and group B in residual gastric volume and the incidence of regurgitation, bucking and aspiration （P 〉0. 05）. However, there were 8 cases （13. 33%） of gastric tube twisting or knotting in stomach in group A, and 2 cases （ 3. 33%） of gastric tube entering the duodenum. Conclusions Indwelling gastric tube with the length of 55 -65 cm （ from eyebrow to navel） is simple and reasonable for stroke patients in patients with different height, so it is worthy of promotion in clinical practice.