肠衣包绕尖端提高鼻肠管被动等待置管法置管效率的效果研究

Effect of casing wrapping tip on improving the efficiency of passive waiting catheterization of naso⁃intestinal tube

目的:探讨肠衣包绕尖端改良的鼻肠管被动等待置管法对鼻肠管置管结局和置管周期的影响。方法:采用随机对照的方法,将2家三级甲等医院的146例重症监护室鼻肠管置管病人随机分为对照组78例和干预组68例,对照组给予常规被动等待置管法,干预组给予改良的被动等待置管法,即置管前使用可食用天然肠衣包绕鼻肠管尖端,待置管至胃内后从鼻肠管向肠衣内注入碳酸氢钠延缓肠衣被胃液消化的进程,依靠胃蠕动将膨胀的鼻肠管尖端带入十二指肠,提高置管效率。比较两组置管结局和置管周期。结果:干预组病人12 h置管成功率显著高于对照组(P<0.05),而两组病人48 h置管成功率比较差异无统计学意义(P>0.05);干预组鼻肠管的置管周期显著降低,除此之外,急性胃肠损伤分级(AGI)、镇静剂的使用、置管前肠鸣音次数都会对置管结果和置管周期产生影响。结论:改良的鼻肠管被动等待置管法提高了鼻肠管的置管效率,缩短了平均置管成功时间,有利于早期肠内营养的开展。

Objective:To explore the effect of the improved passive waiting for the nasointestinal with the casing wrap around the tip on the outcome of nasointestinal feeding tube placement(NFTP)and placement period.Methods:Randomized controlled trials were used to divide 146 ICU patients needed nasointestinal from two tertiary grade A hospitals into control group of 78 cases and intervention group of 68 cases.The control group was given a conventional passive waiting method.The intervention group was given a modified passive waiting method,which was using an edible natural casing to wrap the tip of the nasointestinal tube before placing the tube,after placing the tube into the stomach,inject sodium bicarbonate from the nasointestinal tube into the casing to delay the digestion gastric juice,in order to improve tube placement efficiency.The outcome of the tube placement and the period of placement were compared between the two groups.Results:The success rate of the 12⁃hour NFTP in the intervention group were significantly higher than that in the control group(P<0.05),while the 48⁃hour NFTP success rate was not significantly different between the two groups of patients(P>0.05).The placement period of NFTP was significantly reduced in the intervention group.In addition,the AGI score,the use of sedatives,and the number of bowel sounds per minute also affected the placement result and period.Conclusion:The improved tube passive waiting placement method improved the efficiency of NFTP placement,shortened the average successful time of intubation,and it is beneficial to the development of early enteral nutrition.