不同途径置胃管洗胃的适应群研究
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摘要
目的通过回顾一定数量的口服中毒需要洗胃病例,总结出不同途径置胃管洗胃的适应群。方法回顾性调查2012年1月～2016年1月急诊科就诊的336例口服药物中毒成功置管洗胃病例,根据不同途径置管分为两组:经口组、经鼻组。回顾病例书写内容:病史、患者病情、选择洗胃管插管途径、并发症等。结果存在口腔疾病的患者经鼻置管成功例数较多,存在鼻腔病史的经口置管成功例数较多,而经口或鼻置管的患者黏膜均存在不同程度的黏膜破损。根据患者药物中毒后不同就诊时间置管洗胃堵塞率有所差异,经口组组内比较,越近就餐时间堵塞率越高,经鼻组的堵塞率较经口组高,差异有统计学意义(P<0.05)。结论置胃管前,护士及时评估病史、病情至关重要,根据具体情况不同快速选择不同插管途径,减少插管时间及提高一次插管成功率。
Objective To summarize the adaptation group of different routes of gastric tube placing for gastric lavage by reviewing a certain number of cases with oral poisoning in need of gastric lavage. Methods A total of 336 cases of oral drug poisoning in the emergency department who were successfully given tube placing and gastric lavage from January2012 to January 2016 were retrospectively investigated. According to different routes of tube placing, the two groups were divided into the oral group and the nasal group. The case writing contents were reviewed, including medical history,patients' condition, choice of routes of tube placing for gastric lavage, complications, etc. Results There were more successful cases of nasal tube placement in the patients with oral diseases. There were more successful cases of oral tube placement in the patients with the history of nasal diseases. There were different degrees of mucosal damages in the mucosa of patients receiving oral or nasal tube placement. According to the different treatment visit time after patients' drug poisoning, the clogging rates of tube placing for gastric lavage were different. The comparison was carried out within the oral group, and the clogging rate was higher if the eating time was closer to the tube placement time. The clogging rate in the nasal group was higher than that in the oral group, the difference was statistically significant(P<0.05).Conclusion It is utterly important for nurses to timely assess the medical history and conditions before placing the stomach tube. The different intubation routes should be rapidly selected according to specific conditions, so as to reduce the intubation time and increase the success rate of one-time intubation.
Objective To summarize the adaptation group of different routes of gastric tube placing for gastric lavage by reviewing a certain number of cases with oral poisoning in need of gastric lavage. Methods A total of 336 cases of oral drug poisoning in the emergency department who were successfully given tube placing and gastric lavage from January2012 to January 2016 were retrospectively investigated. According to different routes of tube placing, the two groups were divided into the oral group and the nasal group. The case writing contents were reviewed, including medical history,patients' condition, choice of routes of tube placing for gastric lavage, complications, etc. Results There were more successful cases of nasal tube placement in the patients with oral diseases. There were more successful cases of oral tube placement in the patients with the history of nasal diseases. There were different degrees of mucosal damages in the mucosa of patients receiving oral or nasal tube placement. According to the different treatment visit time after patients' drug poisoning, the clogging rates of tube placing for gastric lavage were different. The comparison was carried out within the oral group, and the clogging rate was higher if the eating time was closer to the tube placement time. The clogging rate in the nasal group was higher than that in the oral group, the difference was statistically significant(P<0.05).Conclusion It is utterly important for nurses to timely assess the medical history and conditions before placing the stomach tube. The different intubation routes should be rapidly selected according to specific conditions, so as to reduce the intubation time and increase the success rate of one-time intubation.
引文
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[13]郭金华,许丽.药物中毒抢救中不同途径置胃管洗胃效果比较[J].中国保健营养(上旬刊),2013,23(8):4216-4217.
[14]许玲雪.新生儿经鼻和经口置胃管术的研究[J].当代护士(专科版),2014,(8):12-14.
[15]兰玉清.探讨中毒急救中经口腔和鼻腔插胃管的效果分析[J].中外医疗,2010,29(21):43.
[16]陶莉莉.经口和经鼻置管对急性药物中毒的洗胃效果比较[J].中国乡村医药,2018,25(6):19-20.
[17]张元亚.留置胃管反复洗胃抢救急性有机磷农药中毒患者的临床效果[J].临床医学研究与实践,2017,2(10):70-71.
[18]姜树志.两种置管方式用于急诊药物中毒洗胃的治疗效果对比[J].中国处方药,2017,15(1):9-10.
[19]冯轶,饶正伟,冯刚,等.不同洗胃方式对重度急性有机磷农药中毒69例效果观察[J].现代医药卫生,2016,32(23):3698-3699.
[20]王国富.改进经口插管洗胃方法在口服有机磷农药中毒中的应用体会[J].中华危重病急救医学,2008,20(8):507-507.
[21]祝枝礼,徐彭杰,徐朝霞.可视喉镜引导急性中毒患者困难胃管置入的效果观察[J].临床急诊杂志,2015,16(7):554-555.
[22]俞巧华,江玲娟. 2种新生儿洗胃插管方式的比较[J].现代中西医结合杂志,2005,14(3):330.
[23]黄桂贤,李雪坚.两种洗胃法在小儿口服中毒中的应用效果[J].全科护理,2015,(20):1975-1977.
[24]庞继艾.双腔洗胃管用于小儿中毒抢救[J].中华护理杂志,2004,39(4):300-301.
[25]黎清.经口插胃管洗胃156例体会[J].右江医学,2006,34(3):339.
[26]黄秋莲,邓瑞晖.不同途径插胃管在中毒急救中的应用比较[J].右江民族医学院学报,2004,26(2):214-215.
[27]张雯雯.中毒急救中不同插胃管途径临床观察[J].中外医疗,2010,29(24):101.
[28] Li Y,Tse ML,Gawara mmana I,et al System atic review of controlled clinical trials of gastric lavage in acute organophosphorus pesticide poisoning[J]. Clin Toxicol(Phila),2009,47(3):179-192.
[2]徐云霞.经口置胃管洗胃在药物中毒抢救的临床应用[J].中国现代药物应用,2010,4(23):68.
[3]李怀英.经口中毒患者插管洗胃临床研究进展[J].中国内科医学,2008,3(4):592.
[4]莫明红.急诊中毒昏迷患者洗胃插胃管方法改进[J].护理实践与研究,2009,6(5):107.
[5]陈文军,李先荣,雷海红,等.导丝引导留置胃管应用体会[J].临床医药实践,2010,19(6):455-456.
[6]郝利霞.急诊洗胃插胃管的方法探讨[J].基层医学论坛,2011,15(17):547-548.
[7]宋玲.不同途径置胃管在抢救农药中毒中的应用效果观察[J].全科护理,2010,8(12):1078-1079.
[8]李桂莲.两种插胃管方法洗胃的效果分析及护理[J].国际医药卫生导报,2011,17(2):232-235.
[9]王秀华,郭倩,张永挛.经鼻与经口置胃管洗胃对服毒病人影响的观察[J].广西医学,2004,26(10):1523-1524.
[10]梁俊玲,赵德美.不同途径置胃管洗胃对药物中毒病人影响的观察[J].实用护理杂志,2003,19(19):14-15.
[11]曾艳丽,王国富,胡秀英,等.不同途径置管洗胃对口服中毒患者影响的系统评价及试验序贯分析[J].中国实用护理杂志,2016,32(25):1990-1997.
[12]许烘萍.两种不同途径置管法在中毒患者反复洗胃中的应用[J].当代护士(专科版),2014,(4):110-111.
[13]郭金华,许丽.药物中毒抢救中不同途径置胃管洗胃效果比较[J].中国保健营养(上旬刊),2013,23(8):4216-4217.
[14]许玲雪.新生儿经鼻和经口置胃管术的研究[J].当代护士(专科版),2014,(8):12-14.
[15]兰玉清.探讨中毒急救中经口腔和鼻腔插胃管的效果分析[J].中外医疗,2010,29(21):43.
[16]陶莉莉.经口和经鼻置管对急性药物中毒的洗胃效果比较[J].中国乡村医药,2018,25(6):19-20.
[17]张元亚.留置胃管反复洗胃抢救急性有机磷农药中毒患者的临床效果[J].临床医学研究与实践,2017,2(10):70-71.
[18]姜树志.两种置管方式用于急诊药物中毒洗胃的治疗效果对比[J].中国处方药,2017,15(1):9-10.
[19]冯轶,饶正伟,冯刚,等.不同洗胃方式对重度急性有机磷农药中毒69例效果观察[J].现代医药卫生,2016,32(23):3698-3699.
[20]王国富.改进经口插管洗胃方法在口服有机磷农药中毒中的应用体会[J].中华危重病急救医学,2008,20(8):507-507.
[21]祝枝礼,徐彭杰,徐朝霞.可视喉镜引导急性中毒患者困难胃管置入的效果观察[J].临床急诊杂志,2015,16(7):554-555.
[22]俞巧华,江玲娟. 2种新生儿洗胃插管方式的比较[J].现代中西医结合杂志,2005,14(3):330.
[23]黄桂贤,李雪坚.两种洗胃法在小儿口服中毒中的应用效果[J].全科护理,2015,(20):1975-1977.
[24]庞继艾.双腔洗胃管用于小儿中毒抢救[J].中华护理杂志,2004,39(4):300-301.
[25]黎清.经口插胃管洗胃156例体会[J].右江医学,2006,34(3):339.
[26]黄秋莲,邓瑞晖.不同途径插胃管在中毒急救中的应用比较[J].右江民族医学院学报,2004,26(2):214-215.
[27]张雯雯.中毒急救中不同插胃管途径临床观察[J].中外医疗,2010,29(24):101.
[28] Li Y,Tse ML,Gawara mmana I,et al System atic review of controlled clinical trials of gastric lavage in acute organophosphorus pesticide poisoning[J]. Clin Toxicol(Phila),2009,47(3):179-192.