改良鼻胃肠双腔管两步置管法在神经外科重症患者中的应用

Application of improved two-step nasogastric double-lumen tube catheterization in critical patients in neurosurgery diseases

目的探索一种改良的鼻胃肠双腔管置管两步法,可以床旁徒手完成置管应用于神经外科重症患者;方法收集需行肠内营养的神经外科重症患者120例,采用随机数表法分为传统鼻肠管组(对照组)和改良鼻肠双腔管组(改良组),各60例,分别记录入组时的APACHEⅡ评分及GCS评分、年龄、体质量指数(BMI),收集每例患者鼻肠管置管操作时间,置管前心率及置管过程中的最高心率变化,置管前和置管后14 d的鼻窦CT、胸部CT及营养指标,判断是否出现鼻窦炎、吸入性肺炎、消化道出血、营养液潴留及心律失常等并发症。结果2组入组时APACHEⅡ评分,GCS评分,年龄,BMI比较,差异均无统计学意义(t=1.0598,1.2073,0.3104,0.9268;P=0.2914,0.2297,0.7568,0.3559,P均>0.05)。改良组置管时间(54.4±13)min,对照组置管时间(49.4±12.9)min,改良组置管时间略长于对照组(t=2.1334,P=0.035,P<0.05)。置管过程中,改良组和对照组在心率变化方面比较,差异无统计学意义(P>0.05)。改良组控制鼻窦炎(20.0%,12/60)方面优于对照组(36.7%,22/60)(P<0.05),改良组控制肺炎(26.7%,16/60)方面优于对照组(46.7%,28/60)(P<0.05),改良组控制胃液潴留(5.0%,3/60)方面优于对照组(16.7%,10/60)(P<0.05);2组胃肠道出血及心律失常方面比较,差异无统计学意义(P>0.05)。经过14 d的肠内营养治疗后,改良组白蛋白、前白蛋白、血红蛋白及淋巴细胞计数均好于对照组。结论改良的鼻胃肠双腔管两步置管法可在床头徒手完成,与传统方法比较,尽管置管时间略有延长,但鼻窦炎、吸入性肺炎的发生率明显降低,不增加置管相关并发症发生,同时改良组营养指标明显优于对照组。该两步法安全、有效、便捷,值得临床推广。

Objective To explore an improved two-step method of nasogastric double-lumen tube catheterization,which was performed by hand beside the bed for critical patients in neurosurgery diseases.Methods 120 critical patients in neurosurgery diseases who required enteral nutrition were collected and divided into traditional nasogastric tube group(the control group)and improved nasogastric double-lumen tube group(the improvement group)according to random mumber table method,with 60 patients in each group.Acute physiology and chronic health evaluation(APACHEⅡ)score and Glasgow Coma Scale(GCS)score,age,and body mass index(BMI)at the time of admission were recorded respectively.The operation time of nasogastric tube insertion,the heart rate before tube insertion and the maximum heart rate change during tube insertion,the nasal sinus CT,chest CT and nutuitional indicators of each patient berore tube insertion and 14 days after tube insertion were collected to determine whether there were complications such as nasosinusitis,aspiration pneumonia,gastrointestinal bleeding,nutrient solution retention and arrhythmia.Results There were no statistically significant differences in APACHEⅡ score,GCS score,age and BMI between two groups at the time of admission(t=1.0598,1.2073,0.3104,0.9268;P=0.2914,0.2297,0.7568,0.3559,P>0.05).The catheterization time of the improvement group was(54.4±13)minutes,and the control group was(49.4±12.9)minutes;The catheterization time in the improvement group was slightly longer than that in the control group(t=2.1334,P=0.035,P<0.05).There was no statistically significant difference in terms of heart rate changes between the improvement group and the control group during catheterization(P>0.05).The improvement group was superior to the control group in the control of sinusitis(20.0%,36.7%),pneumonia(26.7%,46.7%%)and gastric retention(5.0%,16.7%)(P<0.05).There were no statistically significant differences in gastrointestinal bleeding and arrhythmia between two groups(P>0.05).After 14 days of enteral nutrition treatment,the levels of the albumin,prealbumin,hemoglobin,and lymphocyte counts in the improvement group were better than those in the control group.Conclusion The improved two-step nasogastric double-lumen tube catheterization can be completed by hand at bedside.Compared with traditional methods,although the catheterization time is slightly longer,the incidence of sinusitis and aspiration pneumonia is significantly reduced,and there is no increase of complications ralated to tube insertion;Meanwhile,the levels of nutritional indicators in the improvement group are significantly better than those in the control group.This method is safe,effective and convenient,and is worthy of clinical promotion.