超声引导下床旁鼻空肠管置入术在危重患者肠内营养中的应用
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摘要
目的探讨超声引导下床旁鼻空肠管置入术在危重患者肠内营养中的应用效果。方法将112例危重患者随机分为对照组与观察组,各56例。对照组行胃内注气盲置鼻肠管肠内营养干预,观察组行超声引导下床旁鼻空肠管置入干预。比较2组置管成功率、并发症发生率、营养指标水平等情况。结果观察组一次性置管成功率高于对照组(87. 50%vs. 71. 43%,P <0. 05);观察组导管幽门通过、到达胃部、总置管及达到目标营养值时间均短于对照组,置管费用少于对照组(P <0. 05);观察组导管移位的发生率均明显低于对照组(P <0. 05);置管营养7d后,对照组体质量指数(BMI)及营养指标水平均明显低于置管前(P <0. 05),观察组BMI及营养指标水平稳定,且明显高于对照组(P <0. 05)。结论超声引导下床旁鼻空肠管置入术置管成功率高,置管时间短,并发症发生率低,适用于危重患者肠内营养。
Objective To evaluate the application value of ultrasound-guided bedside nasal-jejunal catheterization in enteral nutrition of critically-ill patients. Methods Totally 112 criticallyill patients were randomly divided into control group( n = 56,blind placement of nasointestinal feeding by gastric gas injection) and observation group( n = 56,ultrasound-guided bedside nasaljejunal feeding). The success rate of catheterization,incidence of complications and levels of nutritive indexes were compared between two groups. Results The success rate of catheterization once in observation group was higher than that in control group( 87. 50% vs. 71. 43%,P <0. 05). The observation group was superior to control group regarding the time of tube to pass pylorus and reach the stomach,total catheterization time,time to achieve the target nutritional value and catheterization cost( P < 0. 05). The incidences of tube misplacement was lower than that in control group( P < 0. 05). Seven days after placement,the body mass index( BMI) and levels of nutritive indexes in control group went down markedly when compared with pre-placement( P <0. 05). However,both BMI and levels of nutritive indexes in observation group were relatively stable,and were higher than those in control group( P < 0. 05). Conclusion Ultrasound-guided bedside nasal-jejunal catheterization is characterized by high success rate and short time of catheterization as well as low incidence of complications,suitable for the enteral nutrition in criticallyill patients.
Objective To evaluate the application value of ultrasound-guided bedside nasal-jejunal catheterization in enteral nutrition of critically-ill patients. Methods Totally 112 criticallyill patients were randomly divided into control group( n = 56,blind placement of nasointestinal feeding by gastric gas injection) and observation group( n = 56,ultrasound-guided bedside nasaljejunal feeding). The success rate of catheterization,incidence of complications and levels of nutritive indexes were compared between two groups. Results The success rate of catheterization once in observation group was higher than that in control group( 87. 50% vs. 71. 43%,P <0. 05). The observation group was superior to control group regarding the time of tube to pass pylorus and reach the stomach,total catheterization time,time to achieve the target nutritional value and catheterization cost( P < 0. 05). The incidences of tube misplacement was lower than that in control group( P < 0. 05). Seven days after placement,the body mass index( BMI) and levels of nutritive indexes in control group went down markedly when compared with pre-placement( P <0. 05). However,both BMI and levels of nutritive indexes in observation group were relatively stable,and were higher than those in control group( P < 0. 05). Conclusion Ultrasound-guided bedside nasal-jejunal catheterization is characterized by high success rate and short time of catheterization as well as low incidence of complications,suitable for the enteral nutrition in criticallyill patients.
引文
[1]商雄跃.超声引导胃内注水鼻肠管置入法在ICU脑外伤患者肠内营养中的应用[J].川北医学院学报,2017,32(1):60-63.
[2]李小冬,王崇高,潘峰,等.超声引导鼻肠管置入术在急性重症胰腺炎早期肠内营养中的应用价值[J].贵州医药,2016,40(11):1161-1162.
[3]赵庆华,皮红英,周颖.超声检测与注射器抽吸肠内营养患者胃残余量比较[J].护理学杂志,2017,32(12):54-55.
[4]吴筱箐,陈德生,杜时雨,等.超声引导与胃镜引导鼻肠管置入术临床应用的比较分析[J].中国医师杂志,2017,9(5):708-711.
[5]ASHTON J J,GAVIN J,BEATTIE R M.Exclusive enteral nutrition in Crohn's disease:Evidence and practicalities[J].Clin Nutr,2018,12(8):88-89.
[6]CORIAT R,POLIN V,OUDJIT A,et al.Gastric emptying evaluation by ultrasound prior colonoscopy:An easy tool following bowel preparation[J].World J Gastroenterol,2014,20(37):13591-13598.
[7]邓岩军,吴雪梅,谢红,等.超声测定胃排空功能指导重症机械通气患者肠内营养的临床应用[J].中华老年多器官疾病杂志,2016,15(7):533-536.
[8]REINTAM A B,STARKOPF J,ALHAZZANI W,et al.Early enteral nutrition in critically ill patients:ESICMclinical practice guidelines[J].Intensive Care Med,2017,43(3):380-398.
[9]王晓燕.超声检查测定胃动力指导心脏手术后机械通气患儿肠内营养应用临床效果观察[J].世界最新医学信息文摘,2016,16(55):87.
[10]COMPTON F,BOJARSKI C,SIEGMUND B,et al.Use of nutrition support protocol to increase enteral nutrition delivery in critically ill patients[J].Am JCrit Care,2014,23(5):396-403.
[11]JIANG C,ZHOU Q.Effects of postoperative enteral nutrition opportunity on the recovery of gastrointestinal function in patients with esophageal cancer[J].Hebei Med J,2018,23(4):990-1000.
[12]曹岚,叶向红,李君,等.床旁超声检测胃残余量在神经外科重症患者场内营养中的应用[J].中华医学杂志,2017,97(9):675-678.
[13]郑红雨,卢国浩,康利克,等.重症患者超声引导下置入液囊空肠管与鼻空肠管的对比研究[J].中国超声医学杂志,2012,28(12):1117-1119.
[14]罗亮,屠苏,张振伟,等.超声引导下床旁鼻空肠管置入术在危重患者肠内营养中的应用[J].实用医学杂志,2009,25(11):1845-1846.
[15]陈惠萍,邓颖辉,叶新梅,等.两种鼻肠管置管法应用于克罗恩病患者的效果观察[J].护理实践与研究,2016,13(6):47-48.
[2]李小冬,王崇高,潘峰,等.超声引导鼻肠管置入术在急性重症胰腺炎早期肠内营养中的应用价值[J].贵州医药,2016,40(11):1161-1162.
[3]赵庆华,皮红英,周颖.超声检测与注射器抽吸肠内营养患者胃残余量比较[J].护理学杂志,2017,32(12):54-55.
[4]吴筱箐,陈德生,杜时雨,等.超声引导与胃镜引导鼻肠管置入术临床应用的比较分析[J].中国医师杂志,2017,9(5):708-711.
[5]ASHTON J J,GAVIN J,BEATTIE R M.Exclusive enteral nutrition in Crohn's disease:Evidence and practicalities[J].Clin Nutr,2018,12(8):88-89.
[6]CORIAT R,POLIN V,OUDJIT A,et al.Gastric emptying evaluation by ultrasound prior colonoscopy:An easy tool following bowel preparation[J].World J Gastroenterol,2014,20(37):13591-13598.
[7]邓岩军,吴雪梅,谢红,等.超声测定胃排空功能指导重症机械通气患者肠内营养的临床应用[J].中华老年多器官疾病杂志,2016,15(7):533-536.
[8]REINTAM A B,STARKOPF J,ALHAZZANI W,et al.Early enteral nutrition in critically ill patients:ESICMclinical practice guidelines[J].Intensive Care Med,2017,43(3):380-398.
[9]王晓燕.超声检查测定胃动力指导心脏手术后机械通气患儿肠内营养应用临床效果观察[J].世界最新医学信息文摘,2016,16(55):87.
[10]COMPTON F,BOJARSKI C,SIEGMUND B,et al.Use of nutrition support protocol to increase enteral nutrition delivery in critically ill patients[J].Am JCrit Care,2014,23(5):396-403.
[11]JIANG C,ZHOU Q.Effects of postoperative enteral nutrition opportunity on the recovery of gastrointestinal function in patients with esophageal cancer[J].Hebei Med J,2018,23(4):990-1000.
[12]曹岚,叶向红,李君,等.床旁超声检测胃残余量在神经外科重症患者场内营养中的应用[J].中华医学杂志,2017,97(9):675-678.
[13]郑红雨,卢国浩,康利克,等.重症患者超声引导下置入液囊空肠管与鼻空肠管的对比研究[J].中国超声医学杂志,2012,28(12):1117-1119.
[14]罗亮,屠苏,张振伟,等.超声引导下床旁鼻空肠管置入术在危重患者肠内营养中的应用[J].实用医学杂志,2009,25(11):1845-1846.
[15]陈惠萍,邓颖辉,叶新梅,等.两种鼻肠管置管法应用于克罗恩病患者的效果观察[J].护理实践与研究,2016,13(6):47-48.