不同盲插螺旋型鼻肠管方法在神经重症患者中的应用

Application of different blind insertion methods of spiral nasointestinal tubes in critically neurological patients

目的探讨腹部按摩刺激胃起搏点或采用促胃动力药提高神经重症患者螺旋型鼻肠管置管成功率的效果及安全性。方法将本院神经重症监护室需行肠内营养支持的90例神经重症患者分为腹部按摩组、甲氧氯普胺组和对照组(单纯盲插组),统计分析3组置管成功率,并评价其安全性。结果腹部按摩组72 h置管成功率为93. 33%,甲氧氯普胺组为70. 00%,对照组为53. 33%,3组间置管成功率差异有统计学意义(P <0. 05);腹部按摩组与甲氧氯普胺组的呕吐发生率均显著低于对照组(P <0. 05); 3组腹泻、反流、误吸发生率差异无统计学意义(P> 0. 05)。结论腹部按摩刺激胃起搏点、甲氧氯普胺均可提高螺旋型鼻肠管置管成功率,但腹部按摩刺激胃起搏点较甲氧氯普胺注射液更能提高置管成功率。

Objective To investigate the effect and safety of abdomen massage to stimulate gastric pacemaker and metoclopramide on improving the success rate of spiral nasointestinal catheterization in critically neurological patients.Methods A total of 90 patients with enteral nutrition support in the neurological intensive care unit in our hospital were divided into abdominal massage group,metoclopramide group and control group (simple blind insertion group).The success rate of catheterization and its safety were compared.Results The success rate of catheterization was 93.33% in the abdominal massage group,70% in the metoclopramide group,and 53.33% in the control group,there was a statistically significant difference in three groups(P<0.05).The incidence of vomiting in the abdominal massage group and the metoclopramide group was significantly lower than that in the control group (P<0.05).There was no significant difference in the incidence of diarrhea,reflux,and aspiration(P>0.05).Conclusion Stimulating the gastric pacemaker by abdominal massage,and the use of the gastric motility drug metoclopramide can improve the success rate of spiral nasal tube placement,but stimulating gastric pacing by abdominal massage can improve the success rate of catheterization compared with metoclopramide injection.