四磨汤口服液提高重症患者螺旋型鼻肠管幽门后置管成功率的可行性研究

目的评价四磨汤口服液提高重症患者螺旋型鼻肠管幽门后置管的成功率和安全性。方法对20例采用被动等待法床旁放置螺旋型鼻肠管的重症患者给予四磨汤口服液,置管24 h后行床旁腹部X线摄片确认管端位置,鼻肠管末端位于幽门后为置管成功。结果置管24 h后成功率为68. 4%,未观察到严重置管并发症及药物相关不良反应。结论四磨汤口服液用于提高重症患者螺旋型鼻肠管幽门后置管成功率安全、有效。     

重症患者被动等待法结合补救性盲插法放置螺旋型鼻肠管的可行性

目的:探讨重症患者被动等待法结合补救性盲插法放置螺旋型鼻肠管的安全性和有效性.方法:60例重症患者采用被动等待法床边放置螺旋型鼻肠管,常规给予甲氧氯普胺,观察24 h后行床边X线腹部摄片明确管端位置.对管道未通过幽门的病例,心电监测下采用双导丝置管法补救性床边盲插螺旋型鼻肠管后,再次行床边X线腹部摄片确认管端位置.观察置管成功率、并发症发生率以及药物不良反应.结果:采用被动等待法24h后成功率为58.3％(35/60),对25例管道未通过幽门的病例采用双导丝置管法补救性床边盲插螺旋型鼻肠管,置管成功率为72.0％(18/25),被动等待法结合补救性盲插法的总体成功率为88.3％(53/60).未发生严重置管并发症及药物不良反应.结论:重症患者被动等待法结合补救性盲插法放置螺旋型鼻肠管安全、有效.     

床旁鼻肠管主动留置术配合患者吸气运动在ICU中的应用

目的:通过配合患者吸气运动时缓慢进管的方法为ICU患者实施床旁鼻肠管主动留置技术,从而实现经鼻肠管给予幽门后喂养,开展早期肠内营养。方法:选取2017年12月1日～2019年6月30日需行幽门后喂养的患者30例,在床旁主动留置鼻肠管过程中,操作者配合患者吸气运动,顺势缓慢送管至置管所需刻度,初步判断肠管到达十二指肠的位置,以腹部X线检查作为鼻肠管定位的"金标准",以鼻肠管末端到达十二指肠水平部及以后作为置管成功的标准。结果:30例患者中,29例置管成功,腹部X线检查均显示鼻肠管到位,尽早顺利开展肠内营养;1例患者失败,采用被动等待法留置成功。结论:在床旁鼻肠管主动留置过程中,配合患者吸气运动,缓慢送管至所需刻度,置管成功率高,能促进患者尽早实施肠内营养。     

温热水刺激鼻肠管主动留置在危重患者中的应用

目的:探讨45~47 ℃温热水刺激鼻肠管主动留置在危重患者中的应用效果。方法:选取2018年12月1日~2020年1月31日在青岛市某三级甲等医院重症医学科住院需留置鼻肠管的76例患者作为研究对象,在床旁主动留置鼻肠管过程中,通过分次间断注入45~47 ℃温热水,刺激胃肠蠕动,提高鼻肠管置管成功率。结果:76例患者中,其中一次性置管成功71例,成功率为93.42%;5例一次性置管失败患者,给予再次温热水刺激置管,成功3例,剩余2例2次置管均未成功,给予被动等待技术均置管成功。结论:在重症医学科危重患者床旁主动留置鼻肠管过程中,通过注入45~47 ℃温热水刺激胃肠蠕动,能够保证置管成功率,尽快实现幽门后喂养,为危重患者早期肠内营养的实施建立有效途径。该方法操作简便,值得临床推广。     

螺旋型鼻肠管置管在神经外科重症患者中的成功率及影响因素

目的研究螺旋型鼻肠管在神经外科重症患者置管成功的几率及其影响因素。方法回顾性纳入2016年12月~2017年5月在中南大学湘雅医院神经外科重症监护室内接受留置螺旋鼻肠管的126例重症患者为研究对象,采用主动置管法结合补救性改良被动等待法置管,观察置管后的幽门通过率。统计患者一般资料、格拉斯昏迷评分(GCS)、病情相关指标及应用药物等数据,采用单因素分析和多元Logistic回归分析置管成功的影响因素。结果螺旋型鼻肠管总的置管成功率为89.68%;单因素统计分析表明诊断类型、GCS评分、应用亚低温治疗、人工气道及去甲肾上腺素等为置管成功的影响因素;多元Logistic回归分析表明诊断类型、应用去甲肾上腺素、人工气道为幽门后置管的独立影响因素。结论将主动置管法结合补救性改良被动等待法应用于螺旋型鼻肠管放置中能提高置管成功率;留置人工气道和使用去甲肾上腺素患者置管成功率低,与脑出血患者相比,脑外伤患者鼻肠管置管成功率低。     

温热水刺激下被动等待技术在超声引导鼻肠管置管困难患者中的应用

目的 探究45～47℃温热水刺激下被动等待鼻肠管留置技术在超声引导置管困难患者中的应用效果。方法 纳入2020年4月1日－2021年3月31日入住青岛市某三级甲等医院重症医学科需留置鼻肠管，且在超声引导下置管困难的48名患者为研究对象，采用温热水刺激下被动等待鼻肠管留置技术进行鼻肠管留置。结果 纳入研究的48名患者中，40名患者采用温热水刺激下被动等待鼻肠管留置技术一次置管成功，占比83.33%；置管失败的8名患者中，7名患者在病情允许的情况下采用床旁胃镜下置管或X线下置管成功，1名患者采用肠外营养联合少量经胃管实施肠内营养进行营养支持。结论 针对鼻肠管置管困难的危重患者，本方法采用改良式被动等待技术同时利用45～47℃温热水刺激胃肠蠕动可保证鼻肠管留置成功率，尽早实施早期肠内营养，操作简便，可以为危重患者早期肠内营养提供可靠途径，值得临床推广。     

肠衣包绕尖端提高鼻肠管被动等待置管法置管效率的效果研究北大核心

目的:探讨肠衣包绕尖端改良的鼻肠管被动等待置管法对鼻肠管置管结局和置管周期的影响。方法:采用随机对照的方法,将2家三级甲等医院的146例重症监护室鼻肠管置管病人随机分为对照组78例和干预组68例,对照组给予常规被动等待置管法,干预组给予改良的被动等待置管法,即置管前使用可食用天然肠衣包绕鼻肠管尖端,待置管至胃内后从鼻肠管向肠衣内注入碳酸氢钠延缓肠衣被胃液消化的进程,依靠胃蠕动将膨胀的鼻肠管尖端带入十二指肠,提高置管效率。比较两组置管结局和置管周期。结果:干预组病人12 h置管成功率显著高于对照组(P<0.05),而两组病人48 h置管成功率比较差异无统计学意义(P>0.05);干预组鼻肠管的置管周期显著降低,除此之外,急性胃肠损伤分级(AGI)、镇静剂的使用、置管前肠鸣音次数都会对置管结果和置管周期产生影响。结论:改良的鼻肠管被动等待置管法提高了鼻肠管的置管效率,缩短了平均置管成功时间,有利于早期肠内营养的开展。     

床旁放置Corflo鼻肠管在高龄重症患者中的应用

目的总结探讨床旁放置Corflo鼻肠管在高龄重症患者中的应用。方法对我科2013年10月-2014年7月住院的56例高龄重症患者采用CORPAK10-10-10置管方法实施床旁放置Corflo鼻肠管,观察置管时间、置管成功率、置管时及置管后并发症。结果 56例高龄重症患者实施床旁放置Corflo鼻肠管全部成功,置管时间,置管平均深度105cm,置管成功率84.8%,置管后未发生并发症。结论对高龄重症患者采用CORPAK10-10-10置管法放置Corflo鼻肠管,操作简便、置管成功率高、刺激小、并发症少,适用于高龄重症患者。     

分时段注水超声引导下鼻肠管置入在危重型新冠肺炎患者中的应用

目的:总结分时段注水超声引导下危重型新冠肺炎患者置入鼻肠管给予幽门后喂养的护理经验。方法:选取2020年2月收入病区需置入鼻肠管的患者3例,利用超声显像技术定位食道、胃窦、十二指肠球部及十二指肠水平部,通过分时段间断注入温水在超声监测下显影实时监测鼻肠管末端所在位置,为患者床旁主动留置鼻肠管。以腹部X线检查作为鼻肠管定位的“金标准”,以鼻肠管末端到达十二指肠水平部及以后作为置管成功的标准。结果:3例患者腹部X线检查均显示鼻肠管到位。结论:护士着三级防护给予患者置入鼻肠管,难度高、风险大,根据解剖结构预估鼻肠管末端所达到解剖位置,借助超声定位引导和分时段温水注入监测水雾征的床旁主动鼻肠管置入技术,可快速判断鼻肠管末端位置,该方法快速、方便、成功率高,为危重型新冠肺炎患者肠内营养的尽早实施赢得时间。     

三种置入螺旋形鼻肠管方法临床对比研究

目的：探讨床旁经鼻置螺旋形鼻肠管的方法,并与X线辅助鼻肠管置管及胃镜下经异物钳辅助直接置入鼻肠管进行比较。方法分为床旁经鼻盲探下置入鼻肠管组（ A组）46例和X线辅助鼻肠管置管组（B组）30例及胃镜下经异物钳辅助直接置入鼻肠管组（C组）38例,分别进行操作。结果 A组床旁经鼻盲探下置入鼻肠管46例,成功41例,成功率89.1%;B组X线辅助鼻肠管置管30例,成功27例,成功率90.0%;C组胃镜下经异物钳辅助直接置入鼻肠管38例,成功37例,成功率97.4%。 A、B两组比较,差异无显著性;A、B组与C组比较,差异有显著性。结论 X线辅助置管成功率高于常规法,但难以满足解剖结构改变患者的需求。胃镜直视下置管仍优势明显,但需专业人员操作。床旁经鼻置螺旋形鼻肠管,并辅以扩张幽门（胃内注气）、右侧卧位等措施后置管,创伤小,便于临床操作。     

床边幽门后喂养管置管法用于重症患者的初步研究

目的 观察床边徒手幽门后喂养管置管法对重症患者治疗的效果,并对置管成功率、操作时间及安全性进行评价.方法 2009年2月至7月对需幽门后喂养者实施幽门后喂养管置管.使用130 cm长、带导丝的普通鼻胃肠管,操作前静脉给予10 mg甲氧氯普胺.置管过程中依气过水声、真空试验、回抽液pH值以及导丝来综合判断导管位置.开始肠内营养前拍腹部X线平片证实导管头端位置.记录置管时间、成功率、从决定肠内营养到开始喂养的时间以及并发症的发生情况.结果 入选28例患者,主要适应证为:有误吸高风险者18例,胃瘫3例,急性胰腺炎7例.28例患者幽门后置管成功26例,成功率为92.9%;其中21例(占75.0%)到达空肠近段;平均置管时间(20.36±6.41)min;从决定肠内营养到开始喂养时间(4.15±1.68)h.无严重并发症发生.结论 使用普通带导丝鼻胃肠管床边幽门后喂养管置管,一人即可完成操作,是一种安全、简便、性价比高的喂养管置管方法.     

Erythromycin versus metoclopramide for post-pyloric spiral nasoenteric tube placement: a randomized non-inferiority trial

Purpose

To determine whether erythromycin is non-inferior to metoclopramide in facilitating post-pyloric placement of self-propelled spiral nasoenteric tubes (NETs) in critically ill patients.

Methods

A prospective, multicenter, open-label, parallel, and non-inferiority randomized controlled trial was conducted comparing erythromycin with metoclopramide in facilitating post-pyloric placement of spiral NETs in critically ill patients admitted to intensive care units (ICUs) of eight tertiary hospitals in China. The primary outcome was procedure success defined as post-pyloric placement (spiral NETs reached the first portion of the duodenum or beyond confirmed by abdominal radiography 24 h after tube insertion).

Results

A total of 5688 patients were admitted to the ICUs. Of these, in 355 patients there was a plan to insert a nasoenteric feeding tube, of whom 332 were randomized, with 167 patients assigned to the erythromycin group and 165 patients assigned to the metoclopramide group. The success rate of post-pyloric placement was 57.5% (96/167) in the erythromycin group, as compared with 50.3% (83/165) in the metoclopramide group (a difference of 7.2%, 95% CI ??3.5% to 17.9%), in the intention-to-treat analysis, not including the prespecified margin of ??10% for non-inferiority. The success rates of post-D1 (reaching the second portion of the duodenum or beyond), post-D2 (reaching the third portion of the duodenum or beyond), post-D3 (reaching the fourth portion of the duodenum or beyond), and proximal jejunum placement and the incidence of any adverse events were not significantly different between the groups.

Conclusions

Erythromycin is non-inferior to metoclopramide in facilitating post-pyloric placement of spiral NETs in critically ill patients. The success rates of post-D1, post-D2, post-D3, and proximal jejunum placement were not significantly different.

     

Intravenous erythromycin facilitates bedside placement of postpyloric feeding tubes in critically ill adults: a double-blind,randomized, placebo-controlled study

OBJECTIVE To evaluate the efficacy of intravenous erythromycin as a method to facilitate feeding tube placement into the small intestine in critically ill patients.DESIGN Double blind, randomized, controlled trial.SETTING Medical and surgical intensive care units in an academic medical center.PATIENTS Prospective cohort of 36 consecutive adults requiring intensive care unit care and enteral tube feeding for nutritional support.INTERVENTION Infusion of a single dose of intravenous erythromycin (500 mg) or saline before placement of 10-Fr feeding tubes using a standardized active bedside protocol.MEASUREMENTS AND MAIN RESULTS We determined the success rate of feeding tube placement into or beyond the second portion of the duodenum and the time required for this procedure by experienced nurses. The feeding tube was considered to be postpyloric when the tip was in the second portion of the duodenum or beyond. The predictive value of a serial step-up in gastrointestinal aspirate pH from < or = 5.0 to > or = 6.0 was also determined. Use of intravenous erythromycin significantly improved the rate of feeding tube placement into the duodenum or jejunum (erythromycin group, 13 of 14 patients or 93% vs. the control group, 12 of 22 patients or 55%; p < .03). Erythromycin administration also significantly decreased the procedure time from 25 +/- 3 to 15 +/- 2 mins (p < .04). Feeding tube placement into either duodenum or jejunum was confirmed in all 18 patients with a pH step-up from < or = 5.0 to > or = 6.0. CONCLUSION: A single bolus dose of intravenous erythromycin facilitates active bedside placement of postpyloric feeding tubes in critically ill adult patients.     

简化床旁超声法在重症患者鼻肠管定位中的应用价值

目的探讨简化床旁超声法在重症患者鼻肠管定位的应用价值。 方法选择2016年3月至2017年4月台州市立医院重症医学科收治的需留置鼻肠管的患者59例。应用简化床旁超声法定位鼻肠管。超声探及幽门管处鼻肠管声影,且鼻肠管插入长度符合鼻尖至空肠的预计距离,则认为鼻肠管进入空肠。鼻肠管放置结束后,立即进行床旁超声检查及床旁腹部X线检查。以腹部X线检查结果作为验证鼻肠管头端位置的"金标准",计算简化床旁超声法鼻肠管定位的敏感度、特异度、准确性、阳性预测值、阴性预测值。采用Kappa分析分析简化床旁超声法与腹部X线检查对重症患者鼻肠管定位的一致性。 结果简化床旁超声法判定鼻肠管进入空肠50例,腹部X线检查验证49例空肠在位;简化床旁超声法判定鼻肠管未进入空肠9例,腹部X线检查验证4例空肠在位。以腹部X线检查结果作为验证鼻肠管头端位置的"金标准",简化床旁超声法鼻肠管定位的敏感度、特异度、准确性、阳性预测值、阴性预测值分别为92.45%、83.33%、89.83%、98.00%、44.44%。Kappa分析结果显示,简化床旁超声法与腹部X线检查对重症患者鼻肠管定位的一致性Kappa=0.620。 结论简化床旁超声法可以定位鼻肠管,其准确程度高,简单易学,快速方便,具有较好的临床应用价值。     

对危重患者使用双导丝置管法补救性床边盲插螺旋型鼻肠管的方法及安全性研究

目的 介绍对危重患者采用双导丝置管法补救性床边盲插螺旋型鼻肠管的方法,探讨其安全性和有效性.方法 选择2005年7月-2007年3月50例放置螺旋型鼻肠管而不能自行通过幽门的危重患者,在心电监测下,采用双导丝置管法补救性床边盲插螺旋型鼻肠管,观察幽门后置管成功率和并发症发生率.结果 50例患者的平均置管时间为(24.5±4.9)min,置管成功率为82.O%(41/50),2006年7月-2007年3月治疗的后25例患者置管成功率为96.0%(24/25),明显高于2005年7月-2006年7月治疗的前25例[68.0%(17/25)],差异有统计学意义(P相似文献   

Report on the development of a procedure to prevent placement of feeding tubes into the lungs using end-tidal CO2 measurements

OBJECTIVE: To determine the accuracy of a technique using capnography to prevent inadvertent placement of small-bore feeding tubes and Salem sump tubes into the lungs. SETTING: Twelve-bed medical intensive care unit (MICU) in a 557-bed teaching hospital. PATIENTS: A total of 25 ventilated adult MICU patients were studied-5 in phase 1 and 20 in phase 2. DESIGN: Phase 1 tested the ability of the end-tidal CO2 (ETCO2) monitor to detect flow (and thus accurately detect CO2) through small-bore feeding tubes. A small-bore feeding tube, with stylet in place, was placed 5 cm through the top of the tracheostomy tube ventilator adapter in five consecutive patients. The distal end of the feeding tube was attached to the ETCO2 monitor. The ETCO2 level and waveform were assessed and recorded. Because CO2 waveforms were successfully detected, a convenience sample of 20 adult MICU patients who were having feeding tubes placed (13 Salem sump tubes, 7 small-bore feeding tubes) was then studied. The technique consisted of attaching the ETCO2 monitor to the tubes and observing the ETCO2 waveform throughout placement. RESULTS: The study hypothesis was supported. Of the seven small-bore feeding tubes tested, all were successfully placed on initial insertion. Placement was confirmed by absence of an ETCO2 waveform and by radiograph. Of the 13 Salem sump tubes, 9 were placed successfully on first attempt and confirmed by absence of CO2 and by air bolus and aspiration of stomach contents. ETCO2 waveforms were detected with insertion of four of the Salem sump tubes; the tubes were immediately withdrawn, and placement was reattempted until successful. CONCLUSIONS: The technique described is a simple, cost-effective method of assuring accurate gastric tube placement in critically ill patients.     

幽门后喂养对急性胃肠损伤Ⅱ级重症患者预后的影响

目的:探讨螺旋型鼻肠管幽门后喂养对急性胃肠损伤（acute gastrointestinal injury, AGI）Ⅱ级重症患者预后的影响。方法:回顾性分析2012年4月至2019年5月参与广东省人民医院3项螺旋型鼻肠管幽门后置管随机对照试验的AGIⅡ级重症患者的数据。收集患者人口统计学资料以及重症监护病房（inte...     

Electrocardiogram-guided placement of enteral feeding tubes

OBJECTIVE: To evaluate a new electrocardiogram guided method for placing nasoenteral feeding tubes in critically ill patients. DESIGN: Prospective case series. SETTING: Surgical intensive care unit in a tertiary center. PATIENTS: A total of 24 patients requiring enteral feeding tube placement entered the study. INTERVENTION: Standard 10-Fr flexible nasoenteral feeding tubes were inserted under direct vision by the nasal route. Before placement, two electrocardiographic reference recordings were made with the use of epigastric area skin electrodes, each 10 cm lateral to the midline 5 cm above the umbilical line. A continuous electrocardiographic tracing from the feeding tube was then monitored throughout the tube insertion process. A change in QRS axis simultaneous with electrocardiographic waveform change from reference point one to two was presumed to indicate tip passage beyond the midline and into the duodenum. Portable abdominal radiography was performed immediately after the procedure to confirm the anatomical location of the tube tip. MEASUREMENTS AND MAIN RESULTS: In four patients (17%), electrocardiographic tracings in both reference leads were identical and prevented further use of this method. In the remainder, electrocardiogram guided technique compared with portable abdominal radiography confirmed the correct position of the tube tip placed by electrocardiographic guidance. Sensitivity and specificity were 100% and 75%, respectively. CONCLUSION: This report describes a new technique of feeding tube placement. This simple and convenient bedside method allows prompt and safe initiation of enteral nutrition.     

静脉滴注红霉素提高鼻肠喂养管盲插成功率

目的:探讨置管前静脉滴注红霉素是否能提高鼻肠喂养管盲插的成功率。方法:37例危重病人随机分为2组,实验组给予红霉素250mg静脉滴注,对照组给予等容量生理氯化钠静脉滴注;10分钟后盲插鼻肠喂养管。插管完成后3小时行床边X线造影腹部摄片以明确管端位置。结果:静脉滴注红霉素组的置管成功率为58%(11/19),明显高于对照组的置管成功率(22%,4/18),P<0.05。结论:置管前予红霉素250mg静脉滴注可提高鼻肠喂养管盲插成功率。     

Bedside sonographic control for positioning enteral feeding tubes: a controlled study in intensive care unit patients

BACKGROUND AND STUDY AIM: The correct placement of an enteral feeding tube in the duodenum in critically ill patients is usually controlled radiographically. However, a direct bedside method that obviates the need for exposure to radiation would be preferable. The aim of this study was to demonstrate the usefulness of bedside sonographic position control for placing enteral feeding tubes in critically ill patients. PATIENTS AND METHODS: After placement of the enteral feeding tube, the position of the tip was determined using bedside transabdominal ultrasound. Native ultrasound was enhanced by injection of air bubbles into the feeding tube. The tube was regarded as being correctly positioned when the tube was visualized within the second or third parts of the duodenum. Plain abdominal radiographs with contrast served as the gold standard test. RESULTS: A total of 76 consecutive examinations were analyzed. In 12 patients, access to the upper abdominal wall was not possible because of open wounds; in another 13 patients who had undergone extensive abdominal surgery, the duodenum could not be identified and so no conclusion could be reached regarding the position of the tube. In 51/76 patients (67 %) ultrasound identified the duodenum and it was possible to determine the position of the tube (46 true positives and 2 true negatives); the position was incorrectly diagnosed in three patients. The sensitivity was 96 % (95 %CI 87 % - 98 %) and the specificity was 50 % (95 %CI 36 % - 65 %), with a positive predictive value of 94 %. CONCLUSIONS: Bedside sonographic control of the positioning of enteral feeding tubes is very sensitive and can be a valuable alternative to radiological control, especially in patients without open abdominal wounds, external installations, or extensive abdominal surgery.