十二指肠梗阻患者使用鼻胆管行肠内营养的护理

Nursing care of patients with duodenal ileus receiving nasobiliary tube instead of nasal tube for enteral nutrition

目的探讨由于十二指肠良性或恶性梗阻、狭窄导致普通鼻肠管置管困难患者经内镜置入鼻胆管替代鼻肠管行肠内营养的效果及护理。方法回顾性分析2016年1月至2017年1月南京大学医学院附属鼓楼医院27例十二指肠良性或恶性梗阻、狭窄致普通鼻肠管置入困难改经内镜放置鼻胆管,通过鼻胆管输注肠内营养制剂的患者的临床护理资料,观察置管时间、一次置管成功率、意外拔管率和肠内营养期间的相关并发症等。结果27例患者均一次性置管成功,置管最长时间为30d,最短为10d。所有患者留置鼻胆管行肠内营养期间均未出现出血、穿孔和误吸等并发症,无意外拔管、脱管及机械性压疮等护理不良事件。结论对因十二指肠良性或恶性梗阻、狭窄导致普通鼻肠管置管困难的患者经内镜置入鼻胆管行短期肠内营养具有可行性,但鼻胆管的材质较普通鼻肠管硬,管腔偏细,护理难度较大,对护理提出更高的要求,个性化精细的护理是保证经鼻肠管肠内营养顺利进行、提高患者生存质量的关键。

Objective To investigate the effect of enteral nutrition by endoscopic placement of nasal bile duct. Methods Twenty-seven patients with duodenal ileus from Jan.2016 to Jan.2017 in Drum Tower Hospital affiliated to Medical School of Nanjing University were analyzed retrospectively who were infused enteral nutrition through nasobiliary.The catheterization time, success rate of tube placement, accidental extubation rate and related complications during enteral nutrition were analyzed. Results All of the patients were successfully placed at once with the success rate of tube placement reaching 100%.The maximum time for tube placement was 30 d , and the shortest time was 10 d.No complications including bleeding, perforation and aspiration during enteral nutrition as well as accidental extubation, tube removal, tube occlusion and mechanical pressure ulcers occurred. Conclusions Due to benign or malignant obstruction and stenosis of the duodenum, it is feasible to replace the common nasointestinal tube by endoscopic placement of a nasobiliary tube in patients with difficult nasointestinal catheterization.Because of the material properties, the personalized and careful nursing is the key to ensure the smooth progress of enteral nutrition and improve the life quality of patients.