不同盲插螺旋型鼻肠管方法在神经重症患者中的应用
|
摘要
目的探讨腹部按摩刺激胃起搏点或采用促胃动力药提高神经重症患者螺旋型鼻肠管置管成功率的效果及安全性。方法将本院神经重症监护室需行肠内营养支持的90例神经重症患者分为腹部按摩组、甲氧氯普胺组和对照组(单纯盲插组),统计分析3组置管成功率,并评价其安全性。结果腹部按摩组72 h置管成功率为93. 33%,甲氧氯普胺组为70. 00%,对照组为53. 33%,3组间置管成功率差异有统计学意义(P <0. 05);腹部按摩组与甲氧氯普胺组的呕吐发生率均显著低于对照组(P <0. 05); 3组腹泻、反流、误吸发生率差异无统计学意义(P> 0. 05)。结论腹部按摩刺激胃起搏点、甲氧氯普胺均可提高螺旋型鼻肠管置管成功率,但腹部按摩刺激胃起搏点较甲氧氯普胺注射液更能提高置管成功率。
Objective To investigate the effect and safety of abdomen massage to stimulate gastric pacemaker and metoclopramide on improving the success rate of spiral nasointestinal catheterization in critically neurological patients. Methods A total of 90 patients with enteral nutrition support in the neurological intensive care unit in our hospital were divided into abdominal massage group,metoclopramide group and control group( simple blind insertion group). The success rate of catheterization and its safety were compared. Results The success rate of catheterization was 93. 33% in the abdominal massage group,70% in the metoclopramide group,and 53. 33% in the control group,there was a statistically significant difference in three groups( P < 0. 05). The incidence of vomiting in the abdominal massage group and the metoclopramide group was significantly lower than that in the control group( P < 0. 05). There was no significant difference in the incidence of diarrhea,reflux,and aspiration( P > 0. 05). Conclusion Stimulating the gastric pacemaker by abdominal massage,and the use of the gastric motility drug metoclopramide can improve the success rate of spiral nasal tube placement,but stimulating gastric pacing by abdominal massage can improve the success rate of catheterization compared with metoclopramide injection.
Objective To investigate the effect and safety of abdomen massage to stimulate gastric pacemaker and metoclopramide on improving the success rate of spiral nasointestinal catheterization in critically neurological patients. Methods A total of 90 patients with enteral nutrition support in the neurological intensive care unit in our hospital were divided into abdominal massage group,metoclopramide group and control group( simple blind insertion group). The success rate of catheterization and its safety were compared. Results The success rate of catheterization was 93. 33% in the abdominal massage group,70% in the metoclopramide group,and 53. 33% in the control group,there was a statistically significant difference in three groups( P < 0. 05). The incidence of vomiting in the abdominal massage group and the metoclopramide group was significantly lower than that in the control group( P < 0. 05). There was no significant difference in the incidence of diarrhea,reflux,and aspiration( P > 0. 05). Conclusion Stimulating the gastric pacemaker by abdominal massage,and the use of the gastric motility drug metoclopramide can improve the success rate of spiral nasal tube placement,but stimulating gastric pacing by abdominal massage can improve the success rate of catheterization compared with metoclopramide injection.
引文
[1]中华医学会神经外科学分会,中国神经外科重症管理协作组.中国神经外科重症患者消化与营专家共识(2016)[J].中华医学杂志,2016,96(21):1643-1647.
[2]吴樱,杜长虹.鼻胃管和螺旋型鼻肠管在重症颅脑疾病患者中引起返流误吸风险的对比研究[J].护士进修杂志,2014,29(24):2213-2215.
[3]雷燕妮,蔡卫新,李桂云,等.螺旋型鼻肠管在脑损伤患者中的幽门通过率及影响因素[J].中国临床营养杂志,2008,16(4):223-227.
[4]陈纯波,曾红科,吴粤,等.红霉素甲氧氯普胺提高螺旋型鼻肠管幽门后置管成功率的研究[J].中国实用内科杂志,2009,29(1):39-41.
[5]陈维生,张一臣,胡北,等.促胃动力药在神经重症患者螺旋型鼻肠管置管中的应用[J].实用医学杂志,2013,29(20):3343-3345.
[6]邓民强.早期肠内营养支持在重型颅脑损伤患者中的应用效果[J].中国实用神经疾病杂志,2013,16(6):14-16.
[7]周敏,尹华华,朱京慈.乳酸杆菌对重型颅脑损伤大鼠胃动素及降钙素基因相关肽影响的实验研究[J].护理研究,2011,25(7):578-581.
[8] Mentec H,Dupont H,Bocchetti M,et al. Upper digestive intolerance during enteral nutrition in critically ill patients:frequency,risk factors,and complications[J]. Crit Care Med,2001,29(10):1955-1961.
[9] Corke C. Gastric emptying in the critically ill patient[J]. Crit Care Resusc,1999,1(1):39-44.
[10] Jing J Y,Huang T C,Wang H Q,et al. Effect of gastric versus post-pyloric feeding on the incidence of pneumonia in critically ill patients:observations from traditional and Bayesian random-effects meta-analysis[J]. Clin Nutr,2013,32(1):8-15.
[11] Van den Bosch S,Witteman E,Kho Y,et al. Erythromycin to promote bedside placement of a self-propelled nasojejunal feeding tube in non-critically ill patients having pancreatitis:a randomized,double-blind,placebo-controlled study[J]. Nutr Clin Pract,2011,26(2):181-185.
[12]胡北,叶珩,陈纯波,等.重症患者螺旋型鼻肠管幽门后置管的影响因素[J].中华急诊医学杂志,2012,21(12):1363-1366.
[13]孟昭泉,宋大庆,苑修太.实用急性中毒急救[M].济南:山东科学技术出版社,2009:465-465.
[14]朱玉.促胃动力药在重症患者螺旋型鼻肠管置管中的应用及护理[J].齐鲁护理杂志,2015,21(23):29-30.
[15]黄伟锋,欧阳守.体表胃肠起搏治疗功能性胃肠道疾病的研究[J].实用医学杂志,2012,28(7):1077-1080.
[16]朱惠芳,杨玉英.脑卒中后便秘患者行腹部按摩的效果评价[J].中国实用护理杂志,2012,28(18):29-30.
[17]谈敏娟,倪静玉,周漪,等.穴位按揉及腹部按摩对急性心肌梗死患者排便的影响[J].中华护理杂志,2006,41(7):655-657.
[2]吴樱,杜长虹.鼻胃管和螺旋型鼻肠管在重症颅脑疾病患者中引起返流误吸风险的对比研究[J].护士进修杂志,2014,29(24):2213-2215.
[3]雷燕妮,蔡卫新,李桂云,等.螺旋型鼻肠管在脑损伤患者中的幽门通过率及影响因素[J].中国临床营养杂志,2008,16(4):223-227.
[4]陈纯波,曾红科,吴粤,等.红霉素甲氧氯普胺提高螺旋型鼻肠管幽门后置管成功率的研究[J].中国实用内科杂志,2009,29(1):39-41.
[5]陈维生,张一臣,胡北,等.促胃动力药在神经重症患者螺旋型鼻肠管置管中的应用[J].实用医学杂志,2013,29(20):3343-3345.
[6]邓民强.早期肠内营养支持在重型颅脑损伤患者中的应用效果[J].中国实用神经疾病杂志,2013,16(6):14-16.
[7]周敏,尹华华,朱京慈.乳酸杆菌对重型颅脑损伤大鼠胃动素及降钙素基因相关肽影响的实验研究[J].护理研究,2011,25(7):578-581.
[8] Mentec H,Dupont H,Bocchetti M,et al. Upper digestive intolerance during enteral nutrition in critically ill patients:frequency,risk factors,and complications[J]. Crit Care Med,2001,29(10):1955-1961.
[9] Corke C. Gastric emptying in the critically ill patient[J]. Crit Care Resusc,1999,1(1):39-44.
[10] Jing J Y,Huang T C,Wang H Q,et al. Effect of gastric versus post-pyloric feeding on the incidence of pneumonia in critically ill patients:observations from traditional and Bayesian random-effects meta-analysis[J]. Clin Nutr,2013,32(1):8-15.
[11] Van den Bosch S,Witteman E,Kho Y,et al. Erythromycin to promote bedside placement of a self-propelled nasojejunal feeding tube in non-critically ill patients having pancreatitis:a randomized,double-blind,placebo-controlled study[J]. Nutr Clin Pract,2011,26(2):181-185.
[12]胡北,叶珩,陈纯波,等.重症患者螺旋型鼻肠管幽门后置管的影响因素[J].中华急诊医学杂志,2012,21(12):1363-1366.
[13]孟昭泉,宋大庆,苑修太.实用急性中毒急救[M].济南:山东科学技术出版社,2009:465-465.
[14]朱玉.促胃动力药在重症患者螺旋型鼻肠管置管中的应用及护理[J].齐鲁护理杂志,2015,21(23):29-30.
[15]黄伟锋,欧阳守.体表胃肠起搏治疗功能性胃肠道疾病的研究[J].实用医学杂志,2012,28(7):1077-1080.
[16]朱惠芳,杨玉英.脑卒中后便秘患者行腹部按摩的效果评价[J].中国实用护理杂志,2012,28(18):29-30.
[17]谈敏娟,倪静玉,周漪,等.穴位按揉及腹部按摩对急性心肌梗死患者排便的影响[J].中华护理杂志,2006,41(7):655-657.