重症急性胰腺炎鼻空肠内营养支持的护理

Nursing of rhino-jejunal nutritional support in severe acute pancreatitis

目的 探讨重症急性胰腺炎 (severe acute pancreatitis,SAP)鼻空肠内营养支持的方法。方法 6 5例 SAP患者胃肠功能恢复后 ,使用聚氨酯材料的 Folcare螺旋形鼻肠管进行营养支持 ,置管时间平均 8.6 d。置管期间每 8h冲洗管道 ,保持营养液在 36 ～ 4 1℃ ,加强口鼻腔护理 ,经常巡视观察。结果所有患者无 1例因鼻空肠内营养的使用而使血、尿淀粉酶升高 ,从而降低了 SAP患者感染性并发症的发生和死亡率 ,治疗费用明显减少 ,缩短了住院天数。结论 鼻空肠内营养是 SAP治疗的重要手段 ,选择合适的鼻空肠管 ,合适的肠内营养 (enteral nutrition,EN)制剂是治疗的前提 ,做好鼻空肠管的日常护理工作是置管营养治疗成功的有力保证。

Objective To discuss nursing care of patients with severe acute pancreatitis (SAP) who are receiving rhino-jejunal nutritional support. Methods Included in this study were 65 SAP patients who were started on rhino-jejunal nutritional support via a spiral nasal enteral tube when their gastrointestinal peristalsis resumed. The mean tube indwelling time was 8.6 days, during which the tube was irrigated every 8 hours, the nutritional solution was kept at an appropriate temperature, and oronasal care and observation were intensified. Results There was not a single case in which serum and urine amylase levels elevated because of the use of nasal enteron nutritional support, thus greatly lowering the incidence of morbidity and mortality, shortening the hospital stay and cutting down on the medical expenses. Conclusions Nasal enteron nutritional support is an important strategy in the treatment of SAP. Selection of an appropriate tube and enteron nutrients is of primary importance; on the other hand, proper routine care of the nasal enteron tube is a guarantee for success of the indwelling nutritional support.