超微可视化系统引导下神经外科重症患者鼻肠管留置效果评价

Evaluation of the retention effect of nasointestinal canal indwelling in severe neurosurgical patients guided by miniature visualization system

目的探讨超微可视化系统引导下鼻肠管留置法在神经外科重症患者中留置的可行性、安全性及合理的操作方法,比较其与传统盲插方法的优劣。方法采用前瞻性随机对照试验设计,便利抽样法选取2022年3月至2023年10月于南京医科大学第一附属医院神经外科需要接受肠内营养支持的128例重症患者为研究对象,采用随机数字表法分为盲插组和可视化组各64例,盲插组通过传统盲插方法进行鼻肠管置入,可视化组通过超微可视化系统引导下鼻肠管留置法进行置入。评价2组患者首次置管成功率和置管时间、并发症、置管期间生命体征的变化和置管结束后营养指标的变化情况。结果盲插组患者男35例,女29例,年龄(59.44±13.84)岁;可视化组男41例,女23例,年龄(58.28±12.08)岁。可视化组首次置管成功率为96.8%(62/64),高于盲插组的82.8%(53/64),2组比较差异有统计学意义(χ^(2)=6.94,P<0.05);可视化组置管时间(20.08±2.69)min,短于盲插组的(38.19±3.79)min,2组比较差异有统计学意义(t=29.99,P<0.05);2组患者并发症发生率比较,差异均无统计学意义(均P>0.05),置管期间生命体征的变化和置管结束后营养指标的变化方面比较,差异均无统计学意义(均P>0.05)。结论与传统盲插鼻肠管相比,超微可视化系统引导下鼻肠管留置法能提高首次置管成功率,缩短置管时间,尽管目前在并发症发生率、置管期间生命体征的变化和置管结束后喂养指标的变化方面无差异,但相信随着该技术的不断发展、升级,会进一步体现出该技术的优势,值得在临床进一步试验及推广应用。

Objective To investigate the feasibility,safety and reasonable operation of nasointestinal canal indwelling guided by miniature system in severe neurosurgery patients,and compare its advantages and disadvantages with traditional blind insertion.Methods A prospective randomized controlled trial design was used to select 128 critically ill patients in need of enteral nutrition support at the Department of Neurosurgery,the First Affiliated Hospital of Nanjing Medical University from March 2022 to October 2023 by convenient sampling method.They were divided into blind insertion group and visualization group by random number table method,with 64 cases in each group.Nasointestinal canal indwelling was performed in the blind insertion group by traditional blind insertion method,and in the visualization group,nasointestinal canal indwelling was performed by indentations guided by the miniature visualization system.The success rate of initial catheterization,the time of catheterization,complications,changes of vital signs during catheterization and changes of nutritional indexes after catheterization were evaluated in 2 groups.Results In the blind insertion group,there were 35 males and 29 females,aged(59.44±13.84)years old.In the visualization group,there were 41 males and 23 females,aged(58.28±12.08)years old.The success rate of the first catheter placement in the visual group was 96.8%(62/64),higher than that in the blind group 82.8%(53/64),and the difference was statistically significant(χ^(2)=6.94,P<0.05).The catheter placement time of the visualization group was(20.08±2.69)min,which was shorter than that of the blind insertion group(38.19±3.79)min,and the difference between the two groups was statistically significant(t=29.99,P<0.05).There was no significant difference in the incidence of complications,changes of vital signs during catheterization and the changes of nutritional indexes after catheterization between two groups(all P>0.05).Conclusions Compared with traditional blind nasointestinal canal indwelling,nasointestinal canal indwelling guided by the miniature visualization system can improve the success rate of the first catheterization and shorten the catheterization time.Although there is no difference in the complication rate,changes in vital signs during catheterization and changes in nutritional indexes after catheterization,it is believed that with the continuous development and upgrading of this technology,it will further reflect the advantages of this technology,which is worthy of further clinical trials and application.