头部左侧后仰法在全麻消化道手术中置入鼻空肠营养管的可行性
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摘要
目的:探讨头部左侧后仰法在全麻消化道手术中置入鼻空肠营养管的可行性。方法:选取2015年6月至2 0 1 7年3月扬州大学附属医院收治的全麻消化道手术患者1 8 0例,将其随机分成A, B, C组,每组60例,A组采取传统方法置入鼻空肠营养管,B组采取可视喉镜置入鼻空肠营养管,C组采取头部左侧后仰法置入鼻空肠营养管,比较3组一次置管成功率、出血率和置管时间。结果:在一次置管成功率和出血率方面,B组与C组差异无统计学意义,与A组相比,差异有统计学意义(P<0.05);在置管时间方面,C组比A组和B组短,差异有统计学意义(P<0.05)。结论:对于气管插管的全麻消化道手术患者,术中置入鼻空肠营养管,采取头部左侧后仰法,可提高鼻空肠营养管置入的成功率,缩短鼻空肠营养管置入时间,减少鼻空肠营养管置入对患者的损伤,减轻护士工作负荷。
Objective: To investigate the feasibility of placing the nasal jejunal feeding tube in the digestive tract operation under general anesthesia with the left back of head. Methods: A total of 180 patients with general anesthesia digestive surgery admitted to our hospital from June 2015 to March 2017 were randomly divided into groups A, B, and C(60 patients in each). Group A was placed in the nose by traditional methods. In the jejunal nutrition tube, group B was placed into the nasal jejunal feeding tube by visual laryngoscope, and group C was placed into the nasal jejunal feeding tube by the left side of the head. The success rate, bleeding rate, and catheterization time were compared. Results: In the one-time tube success rate and bleeding rate, there was no significant difference between group B and group C; there was significant difference between group A and group A(P<0.05). In the tube placement time, group C was significantly different from group A and group B(P<0.05). Conclusion: For patients with general anesthesia and digestive tract surgery for tracheal intubation, intranasal jejunal feeding tube is taken during operation, and the left side of the head is used to improve the success rate of nasal jejunal nutrition tube placement, shorten the placement of nasal jejunal nutrition tube time, reduce the damage to the patient by placing the nasal jejunal nutrition tube, and reduce the nurse's workload.
Objective: To investigate the feasibility of placing the nasal jejunal feeding tube in the digestive tract operation under general anesthesia with the left back of head. Methods: A total of 180 patients with general anesthesia digestive surgery admitted to our hospital from June 2015 to March 2017 were randomly divided into groups A, B, and C(60 patients in each). Group A was placed in the nose by traditional methods. In the jejunal nutrition tube, group B was placed into the nasal jejunal feeding tube by visual laryngoscope, and group C was placed into the nasal jejunal feeding tube by the left side of the head. The success rate, bleeding rate, and catheterization time were compared. Results: In the one-time tube success rate and bleeding rate, there was no significant difference between group B and group C; there was significant difference between group A and group A(P<0.05). In the tube placement time, group C was significantly different from group A and group B(P<0.05). Conclusion: For patients with general anesthesia and digestive tract surgery for tracheal intubation, intranasal jejunal feeding tube is taken during operation, and the left side of the head is used to improve the success rate of nasal jejunal nutrition tube placement, shorten the placement of nasal jejunal nutrition tube time, reduce the damage to the patient by placing the nasal jejunal nutrition tube, and reduce the nurse's workload.
引文
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11.黄月云.镇静加体位改良法在有创机械通气患者留置胃管中的应用[J].护理实践与研究,2012,9(17):95.HUANG Yueyun.Application of sedation plus position improvement method in the placement of nasal jejunal nutrition tube in patients with invasive mechanical ventilation[J].Attend to Practice and Research,2012,9(17):95.
12.范光碧,郑宇杰,周正丽,等.改良法经鼻置胃管的应用解剖学研究[J].中国医学创新,2016,13(16):1-4.FAN Guangbi,ZHENG Yujie,ZHOU Zhengli,et al.The applied anatomic study of inserting the gastric tube through the nasal passage by the improved methods[J].Medical Innovation of China,2016,13(16):1-4.
2.龙谷仔,李观华,贺长春,等.术前肠内营养对胃底贲门癌病人术后康复的影响[J].临床医学,2011,31(12):22-23.LONG Guzai,LI Guanhua,HE Changchun,et al.Ef fect of preoperative enteral nutrition on postoperative rehabilitation of patients with gastric cardia and gastric cardia cancer[J].Clinical Medicine,2011,31(12):22-23.
3.祝慧琴.腹腔镜胆囊切除术置胃管时机的选择[J].浙江临床医学,2006,8(1):102.ZHU Huiqin.The choice of laparoscopic cholecystectomy for nasal jejunal nutrition tube timing[J].Zhejiang Clinical Medicine,2006,8(1):102.
4.罗先武.护理学基础[M].北京:人民卫生出版社,2018:184.LUO Xianwu.Foundation of nursing[M].Beijing:People’s Medical Publishing House,2018:184.
5.Carey M,Al-Hussaini A,Sanu A,et al.Head and neck surgical patients;is it time for a bridle era?[J].Eur Arch Otorhinolaryngol,2014,271(5):1321-1325.
6.董剑云,王芬,张玉琼,等.可视喉镜下全麻患者胃管与鼻饲管并进插入法的应用[J].临床护理杂志,2012,11(6):42-43.DONG Jianyun,WANG Fen,ZHANG Yuqiong,et al.Application of nasal jejunal feeding tube and nasogastric feeding method in general anesthesia under video laryngoscope[J].Journal of Clinical Nursing,2012,11(6):42-43.
7.Mour?o J,Moreira J,Barbosa J,et al.Soft tissue injuries after direct laryngoscopy[J].J Clin Anesth,2015,27(8):668-671.
8.王晓霞.右侧卧位胃管置入法在脑卒中伴吞咽障碍患者中的应用[J].临床护理杂志,2012,11(6):8-9.WANG Xiaoxia.Application of right lateral vaginal nutrition tube placement in stroke patients with dysphagia[J].Journal of Clinical Nursing,2012,11(6):8-9.
9.符钻英,唐汉媛,张梅萍,等.左侧卧位插胃管法在抢救昏迷患者中的应用研究[J].中国医药指南,2010,8(17):29-31.FU Zuany ing,TA NG Hany uan,ZH A NG Meiping.Clinical study on the stomach tube insertion in the left lateral position in rescuing the unconscious patients[J].Guide of China Medicine,2010,8(17):29-31.
10.吕春玲.70°角右侧卧位插胃管法在舌后坠患者中的应用[J].齐鲁护理杂志,2011,17(36):116.LüChunling.Application of 70°right lateral position jejunal feeding tube method in patients with tongue drop[J].Journal of Qilu Nursing,2011,17(36):116.
11.黄月云.镇静加体位改良法在有创机械通气患者留置胃管中的应用[J].护理实践与研究,2012,9(17):95.HUANG Yueyun.Application of sedation plus position improvement method in the placement of nasal jejunal nutrition tube in patients with invasive mechanical ventilation[J].Attend to Practice and Research,2012,9(17):95.
12.范光碧,郑宇杰,周正丽,等.改良法经鼻置胃管的应用解剖学研究[J].中国医学创新,2016,13(16):1-4.FAN Guangbi,ZHENG Yujie,ZHOU Zhengli,et al.The applied anatomic study of inserting the gastric tube through the nasal passage by the improved methods[J].Medical Innovation of China,2016,13(16):1-4.