床旁徒手盲插鼻空肠管在ICU脑科重症患者中的应用

The effect of blind nosojeal tube insertion by hand beside bed in severe brain patients in ICU

目的探讨床旁徒手盲插鼻空肠管在ICU脑科重症患者中的应用效果。方法选取2018年1~12月在广州医科大学附属第六医院(清远市人民医院)院脑科ICU治疗的重症脑损伤患者86例作为研究对象,随机分为观察组和对照组各43例。对照组采用留置胃管的方法行肠内营养供应,观察组采用床旁徒手盲插鼻空肠管的方法行肠内营养供应。比较两组的一次性置管置入成功率、营养状况、并发症发生情况、预后及入住重症监护病房时间。结果两组一次性置管置入成功率比较无显著差异(P>0.05);观察组置管10 d内主观综合营养评价量表(SGA)评分显著优于对照组(P<0.05);观察组胃食管反流及误吸发生率均显著低于对照组(P<0.05),两组腹痛腹泻、上消化道出血/穿孔、吸入性肺炎发生率比较无显著差异(P>0.05);观察组预后显著优于对照组(P<0.05);观察组入住重症监护病房时间显著短于对照组(P<0.05)。结论ICU脑科重症患者采用床旁徒手盲插鼻空肠管行肠内营养供应,一次性置管置入成功率高,可以满足患者的营养需求,并发症少,预后佳,康复快,具有较高的可行性及安全性。

Objective To explore the effect of bedside blind insertion of nasojejunum tube in severe patients with intensive care unit(ICU).Methods A total of 86 patients with severe brain injury who were treated in the brain ICU of the hospital from January to December 2018 were selected as the study subjects,and randomly divided into the observation group and the control group,with 43 cases each.The control group received enteral nutrition supply by indwelling gastric tube,while the observation group received enteral nutrition supply by blind insertion of nasal jejunal tube by hand beside the bed.The success rate of one-time catheterization,nutritional status,complications,prognosis and admission time in ICU were compared between the two groups.Results There was no significant difference in the success rate of one-time catheterization success rate between the two groups(P>0.05).The nutritional status of subjective global nutritional assessment(SGA)in the observation group was significantly higher than that in the control group within 10 days after catheterization(P<0.05).The incidence of gastroesophageal reflux and aspiration in the observation group was significantly lower than that in the control group(P<0.05),and there was no significant differences between the two groups in abdominal pain and diarrhea,upper gastrointestinal bleeding/perforation and inhaled pneumonia(P>0.05).The prognosis of the observation group was significantly better than that of the control group(P<0.05),and the duration of admission to the ICU in the observation group was significantly shorter than that of the control group(P<0.05).Conclusion The one-time catheterization for the supply of enteral nutrition for severe brain patients in ICU is of high success rate,which can meet the nutritional needs of patients with fewer complications,better prognosis,faster recovery,and higher feasibility and safety.