危重患者鼻肠管盲插成功率的影响因素分析

Analysis of influencing factors of the success rate of blind insertion of naso-intestinal tube in critically ill patients

目的:分析重症患者盲插鼻肠管成功率的影响因素。方法:收集2018至2019年应用盲插法行鼻肠管置入的危重症患者,收集其急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)、格拉斯哥昏迷评分(GCS)、Ricker镇静躁动评分(SAS)、血糖、血钾、住院时间、肠鸣音情况、是否有人工气道、是否应用镇静镇痛药物、是否应用血管活性药物、是否手术、是否应用促胃动力药物、是否应用亚低温疗法、是否使用呼吸机以及一般资料,应用Logistic回归分析其影响因素。结果:共收集鼻肠管盲插置入的危重患者156例,132例患者成功置入鼻肠管(84.6%),平均置管用时为(15.1±9.4)min。APACHEⅡ评分≥20分、使用呼吸机是置管成功的危险因素;有肠鸣音是置管成功的保护因素。结论:影响危重患者盲插鼻肠管的因素除自身疾病因素外,药物及治疗干预均可能影响置管,医护人员应尽早评估,早期留置合适的喂养管。

objective:To analyze the influencing factors of the success rate of blind insertion of naso-intestinal tube in critically ill patients.Methods:The critically ill patients who underwent blind insertion of naso-intestinal tube were selected.The patients’acute physiology and chronic health evaluationⅡ(APACHEⅡ),sequential organ failure assessment(SOFA),Glasgow coma score(GCS),Ricker sedation and restlessness score(SAS),blood sugar,potassium,hospitalization time,bowel sounds,artificial airway,sedative and vasoactive drugs,operation,gastric motility drugs,mild hypothermia therapy,mechanical ventilation,and other general datum were collected.Logistic regression was used to analyze its influencing factors.Results:156 critically ill patients with blind insertion of naso-intestinal tube were collected.132 were successfully inserted(84.6%),the average intubation time was 15.1±9.4.APACHEⅡ≥20,mechanical ventilation were risk factors for successful intubation.Bowel sounds was the protective factor for successful intubation.Conclusion:In addition to their own disease factors,drugs and therapeutic interventions may affect the intubation.Medical staff should evaluate as soon as possible and place the appropriate feeding tubes early.