经皮内镜下胃空肠造瘘对危重症患者呼吸机相关性肺炎发生率的影响

目的　通过对在ICU内危重症患者进行经皮内镜下胃空肠造瘘（PEG-J）肠内营养管道的建立,探讨该术式对危重症患者营养状态以及预后的影响。方法　收集常熟市第一人民医院重症医学科2013年1月至2015年12月接受机械通气治疗的58例患者,通过随机数字表分成两组：治疗组（n=28）和对照组（n=30）。治疗组在排除禁忌证后于120 h内建立PEG-J营养支持管道进行肠内营养支持;对照组则选用鼻胃管作为肠内营养支持途径,若患者出现胃排空障碍时则选用鼻肠管。观察两组患者28 d呼吸机相关性肺炎（VAP）发生率以及ICU停留时间、机械通气时间。结果　治疗组患者28 d VAP发生率（7.14%比26.67%,P=0.049)、ICU停留时间［(13.6±5.9)d比(16.8±4.4)d, P=0.024］、机械通气时间［(8.1±5.0)d比(10.7±4.5)d,P=0.041］显著低于对照组。结论　应用PEG-J管道在危重症患者中进行肠内营养支持是可靠、安全的,同时也是降低VAP发生率的一个重要举措。     

胃肠内营养的感染并发症

胃肠内营养支持是营养治疗的主要手段，但其感染性并发症，特别是吸入性肺炎，严重威胁病人生命。本文介绍３例老年男性胃肠内营养支持病例Ｌ（１）例１，食管修补术后多脏器衰竭伴肺部感染，试用胃造瘘管滴入营养液维持未成功，控制感染后改由空肠造瘘滴入营养液成功，病人康复；（２例２，胆囊切除术后多脏器功能衰竭伴重度肺部感染，鼻饲胃管维持营养后出现吸入性肺炎，行胃造兼输注营养液出现腹泻、全复水肿后死亡；（３）例３，     

鼻空肠管和鼻胃管在重型颅脑损伤患者早期肠内营养中应用效果的比较

目的 比较鼻空肠管和鼻胃管在重型颅脑损伤患者早期肠内营养中的应用效果.方法 采用随机数字表法将40例重型颅脑损伤需行早期肠内营养支持的患者随机分为鼻空肠管组和鼻胃管组,每组20例,比较营养支持后两组患者的生化指标、胃肠道耐受和并发症发生情况.结果 营养支持前后,两组患者血清白蛋白、血糖和淋巴细胞计数水平的组间差异均无统计学意义（P均＞0.05）.营养支持后14 d,鼻空肠管组患者的血糖水平较营养支持前明显降低（P=0.0001）.营养支持1周内,鼻空肠管组患者反流（P=0.001）、腹胀（P=0.011）的发生率均明显低于鼻胃管组患者.结论 鼻空肠管对重型颅脑损伤患者早期肠内营养支持效果优于鼻胃管.     

鼻空肠管与鼻胃管肠内营养支持在急诊ICU机械通气患者中的应用效果对比

目的 对比鼻空肠管与鼻胃管肠内营养支持在急诊ICU机械通气患者中的应用效果。方法 70例急诊ICU机械通气患者随机分为两组。对照组留置鼻胃管进行肠内营养支持,观察组留置鼻空肠管进行肠内营养支持。比较两组的营养状况和并发症。结果 观察组的达目标喂养量所需时间短于对照组（P <0.05）。干预后,观察组的HB、 PAB和ALB水平均高于对照组（P <0.05）。观察组的胃肠道并发症总发生率为5.71%,低于对照组的28.57%(P <0.05)。结论 与鼻胃管肠内营养支持相比,鼻空肠管肠内营养支持能够快速改善急诊ICU机械通气患者的营养状况,减少胃肠道并发症的发生。     

急性重症胰腺炎患者经鼻空肠管行早期肠内营养的效果观察

目的 观察急性重症胰腺炎患者行床旁盲插鼻空肠管进行早期肠内营养支持的效果。方法 选取2019年10月—2020年10月厦门大学附属第一医院急诊科收住院的80例急性重症胰腺炎患者作为研究对象,采用随机数字表法分为对照组及观察组。对照组的40例患者采用常规的鼻胃管进行营养支持,观察组对40例患者行床边徒手盲插鼻空肠管后经鼻空肠管内进行营养支持。观察两组患者营养指标、住院日及并发症。结果 两组患者入院当日血清白蛋白和血红蛋白的差异无统计学意义（P> 0.05）,入院第7天、第14天的血清白蛋白和血红蛋白的差异有统计学意义（P<0.05）,住院日差异有统计学意义（P <0.01）;观察组肠内营养不耐受相关并发症,包括呕吐、腹泻、胃潴留、误吸等的发生率较对照组低,差异有统计学意义（P <0.05）。结论 经鼻空肠管对急性重症胰腺炎患者进行早期肠内营养支持比经鼻胃管进行早期营养支持对改善患者的营养状态效果更佳,可缩短住院时间,能有效降低肠内营养不耐受相关并发症的发生。     

经皮内镜下胃造口的临床应用

0 引言 充足地营养支持可以减少危重病人的并发症及改善其预后,当胃肠功能正常时,肠内营养(EN)是营养支持的首选途径.肠内营养可以经鼻胃管、鼻肠管、胃造口和空肠造口等多种途径进行,其中插入鼻胃管或鼻肠管简便易行,但长期使用易造成病人不适.因此,危重病人需要长期肠内营养时,通常进行胃造口或空肠造口,病人耐受较好.传统使用手术胃造口,缺点是并发症多和病死率高,费用高.1980年,非手术经皮内镜下胃造口术(percustanous endoscopic gastrostomy,PEG)被介绍应用于临床,优点是操作简便,并发症少[1].     

经胃管早期肠内营养在重症急性胰腺炎治疗中的临床效果分析

目的：分析经胃管早期肠内营养在重症急性胰腺炎（SAP）治疗中的临床效果及影响。方法：将本院2019年4月至2021年5月内收治SAP患者65例,经动态随机化分组法进行分组（A组、B组）,行对比性临床研究。患者治疗期间均接受早期肠内营养支持治疗,A组（n=33）行鼻空肠管下营养支持、B组（n=32）行经鼻胃管下营养支持。比较两组治疗有效率、相关生物标志物、肠内营养支持相关并发症发生率、全身并发症发生率、营养指标及置管操作时间、置管费用差异。结果：治疗首日患者C-反应蛋白（CRP）、降钙素原（PCT）、肿瘤坏死因素（TNF-α）、微小RNA-216a指标（miR-216a）、营养指标组间对比无统计学差异（P>0.05）;B组治疗7日时肠内营养支持相关并发症发生率、全身并发症发生率、前白蛋白指标、治疗有效率,治疗期间腹痛症状缓解、肠内营养持续、经口进食恢复、住院时间及CT严重指数评分较A组均无统计学差异（P>0.05）;B组治疗7日时CRP、PCT、TNF-α、miR-216a、置管时间及费用低于A组,且B组治疗后白蛋白指标高于A组（P<0.05）。结论：经胃管早期肠内营养...     

经鼻肠管行肠内营养的安全护理

临床营养支持根据供给途径的不同分为肠外营养(PN)和肠内营养(EN)两种.随着对肠道是外科应激的中心器官及肠源性感染的深入认识[1],EN已成为外科营养支持的首选方法.EN是指经口摄食或经鼻胃(肠)管或胃肠造口管输注EN液,以提供代谢需要的营养物质及其他各种营养素的营养支持方式.临床上经鼻肠管行EN支持比较普遍,在护理工作中,护士基本掌握了EN输注的温度、速度和浓度要求,但王婷等[2]提出,在临床工作中,EN的安全问题仍需加强.为了减少鼻肠管EN不良并发症的发生,保证病人EN期间安全,现就鼻肠管EN期间的安全护理作一报道.     

大面积小脑梗死患者术后不同肠内营养方式相关并发症情况

目的　探讨大面积小脑梗死术后患者早期不同肠内营养支持途径的并发症情况，为临床选择合理的肠内营养支持途径提供参考。方法　将符合研究条件的大面积小脑梗死术后患者49例随机分为3组，A组（12例）为常规鼻胃管肠内营养组，B组（18例）为鼻胃管辅以胃肠动力药物治疗组，C组（19例）为鼻空肠管肠内营养组。监测各组在肠内营养开始后3周内的腹泻、反流、误吸、上消化道出血及吸入性肺炎等并发症发生情况，并进行组间统计分析。 结果　3组患者腹泻发生率比较差异无统计学意义（χ2=0.092，P=0.955）；B组及C组反流、误吸及吸入性肺炎的发生率均明显低于A组（均P＜0.05），其中C组最低（与B组比较，P＜0.05）；上消化道出血发生率则以C组较低，与A组及B组比较差异均有统计学意义（χ22=4.748,P2=0.029；χ23=4.284,P3=0.038），而A组与B组发生率比较差异无统计学意义（χ21=0.000,P1=1.000）。结论　鉴于大面积小脑梗死术后患者独特的病理生理学特点，已不适宜采用常规鼻胃管途径进行肠内营养支持；对于预计病程较短的轻症患者可酌情采用鼻胃管辅以胃肠动力药物的肠内营养支持方式；鼻空肠管肠内营养途径各种并发症发生率最低，是重症大面积小脑梗死患者的首选肠内营养途径。     

ICU患者肠内营养的护理

目的 回顾分析ICU危重患者通过管饲给予肠内营养液的护理.方法 对72例危重患者予鼻肠管留置,通过鼻肠管给予肠内营养液支持治疗.结果 72例患者均采用经鼻胃管持续泵入肠内营养液支持治疗,效果较满意.其中56例转入普通病房,3例因无法脱机仍住ICU,8例死亡,5例自动出院.结论 危重患者通过鼻肠管给予肠内营养液,为机体提供营养,保持胃肠黏膜细胞及其功能的完整,促进机体的恢复,效果好.     

Nasogastric tube feeding and percutaneous endoscopic gastrostomy tube feeding in patients with head and neck cancer

Background: For patients with a diagnosis of head and neck cancer, oral nutrition may not provide adequate nutrition during radical radiotherapy or chemoradiation treatment, resulting in enteral feeding initiation. Enteral feeding may be delivered via a nasogastric tube or by a gastrostomy tube. The present study aimed to determine how different treatment modalities impact on requirement for enteral feeding and which method of enteral feeding provided the most benefit to the patient, as demonstrated by weight loss and the number of unscheduled radiotherapy treatment interruptions. Methods: Patients who were treated with radical radiotherapy or chemoradiation between January 2004 and June 2007 were reviewed retrospectively (n = 196, male = 149, female = 47). Data were collected on demographics, diagnosis, T and N classification, nutritional status, unscheduled radiotherapy treatment interruptions, and type and duration of enteral feeding. Subjects were divided into three subgroups depending on the treatment received. Comparisons were then made between methods of enteral feeding. Results: Combined modality treatment (Induction Chemotherapy and Chemoradiation) results in a higher proportion of patients requiring enteral feeding (66–71% compared to 12% for radiotherapy). Patients fed via a prophylactic percutaneous endoscopic gastrostomy lost the least amount of weight during treatment (?4.6% to +1.4%), although the method of enteral feeding did not statistically influence weight difference at the end of treatment. The enteral feeding method did not influence unscheduled radiotherapy treatment interruptions. Conclusions: Combined modality treatment results in a greater requirement for enteral feeding, with these patient groups having the greatest weight loss. The findings obtained in the present study indicate that the method of enteral feeding did not statistically influence weight loss at the end of treatment or unscheduled radiotherapy treatment interruptions.     

Nutritional factors associated with survival following enteral tube feeding in patients with motor neurone disease

Background:  Motor neurone disease (MND) is a progressive neurodegenerative disease leading to limb weakness, wasting and respiratory failure. Prolonged poor nutritional intake causes fatigue, weight loss and malnutrition. Consequently, disease progression requires decisions to be made regarding enteral tube feeding. The present study aimed to investigate the survival, nutritional status and complications in patients with MND treated with enteral tube feeding. Methods:  A retrospective case note review was performed to identify patients diagnosed with MND who were treated with enteral tube feeding. A total of 159 consecutive cases were identified suitable for analysis. Patients were treated with percutaneous endoscopic gastrostomy (PEG), radiologically inserted gastrostomy (RIG) or nasogastric feeding tube (NGT). Nutritional status was assessed by body mass index (BMI) and % weight loss (% WL). Serious complications arising from tube insertion and prescribed daily energy intake were both recorded. Results:  Median survival from disease onset was 842 days [interquartile range (IQR) 573–1263]. Median time from disease onset to feeding tube was PEG 521 days (IQR 443–1032), RIG 633 days (IQR 496–1039) and NGT 427 days (IQR 77–781) (P = 0.28). Median survival from tube placement was PEG 200 (IQR 106–546) days, RIG 216 (IQR 83–383) days and NGT 28 (IQR 14–107) days. Survival between gastrostomy and NGT treated patients was significant (P ≤ 0.001). Analysis of serious complications by nutritional status was BMI (P = 0.347) and % WL (P = 0.489). Conclusions:  Nutritional factors associated with reduced survival were weight loss, malnutrition and severe dysphagia. Serious complications were not related to nutritional status but to method of tube insertion. There was no difference in survival between PEG and RIG treated patients.     

Determination of a practical pH cutoff level for reliable confirmation of nasogastric tube placement

Background: Enteral feeding is a common method of nutrition support when oral intake is inadequate. Confirmation of correct nasogastric (NG) tube placement is essential. Risks of morbidity/mortality associated with misplacement in the lung are well documented. Studies indicate that pH ≤4 confirms gastric aspirate, but in pediatrics, a pH of gastric aspirate is often >4. The goal of this study was to determine a reliable and practical pH value to confirm NG tube placement, without increasing the risk of not identifying a misplaced NG tube. Methods: Pediatric inpatients older than 4 weeks receiving enteral nutrition (nasogastric or gastrostomy) were recruited over 9 months. Aspirate samples were pH tested at NG tube placement and before feedings. If pH >4, NG tube position was confirmed by chest radiograph or further investigations. In addition, intensive care unit (ICU) patients who required endotracheal suctioning were recruited, and endotracheal aspirate samples were pH tested. Results: A total of 4,330 gastric aspirate samples (96% nasogastric) were collected from 645 patients with a median (interquartile range [IQR]) age of 1.0 years (0.3–5.2 years). The mean (standard deviation [SD]) pH of these gastric samples was 3.6 (1.4) (range, 0–9). pH was >4 in 1,339 (30.9%) gastric aspirate samples, and of these, 244 were radiographed, which identified 10 misplaced tubes (1 with pH 5.5). A total of 65 endotracheal aspirate samples were collected from 19 ICU patients with a median (IQR) age of 0.6 years (0.4–5.2 years). The mean (SD) pH of these samples was 8.4 (0.8) (range, 6–9.5). Conclusion: Given that the lowest pH value of endotracheal aspirate sample was 6, and a misplaced NG tube was identified with pH 5.5, it is proposed that a gastric aspirate pH ≤5 is a safer, reliable, and practical cutoff in this population.     

内镜下放置鼻空肠营养管的方法和营养效果分析

目的:探讨分析内镜下放置空肠营养管的方法和营养支持效果。方法:选择106例需放置空肠营养管的病人随机分为观察组54例和对照组52例。此外,选择同期行鼻胃管肠内营养病人43例作为鼻胃管组。对照组采用传统内镜下经鼻空肠营养管置管术;观察组采用改良后内镜下经鼻空肠营养管置管术;鼻胃管组采取常规鼻胃管肠内营养。比较三组病人手术时间、一次性置管成功率、置管后并发症发生率以及病人置管后营养指标变化情况。结果:观察组和鼻胃管组病人手术时间显著短于对照组(P0.05),一次性置管成功率显著高于对照组(P0.05)。三组病人置管后并发症发生率无显著性差异(P0.05)。三组病人置管后血红蛋白、血清清蛋白以及前清蛋白水平均较治疗前显著改善(P0.05)。观察组和对照组病人置管前后营养指标比较均无显著性差异(P0.05),而鼻胃管组病人置管后血红蛋白、血清清蛋白和前清蛋白水平显著低于观察组和对照组(P0.05)。结论:改良内镜下鼻空肠管置管术能有效缩短置管手术时间,提高一次性置管成功率,降低病人置管手术的痛苦。置管后病人营养支持效果显著。     

鼻空肠置管与鼻胃置管两种不同置管方式在改善重型颅脑损伤亚低温状态下早期肠内营养支持中的疗效比较

目的探讨鼻空肠置管与鼻胃置管两种不同置管方式在改善重型颅脑损伤亚低温状态下早期肠内营养支持中的作用,并比较其临床疗效。方法选择120例进行常规亚低温治疗的重型颅脑损伤患者,按简单随机抽样法分为鼻空肠置管肠内营养（鼻空肠置管组）60例及鼻胃置管肠内营养（鼻胃置管组）60例,实施鼻胃置管及鼻空肠置管后,使用肠内营养要素膳和／或肠内高营养多聚合剂实施早期肠内营养支持,两组患者在肠功能存在条件下48h内开始肠内营养,比较两组各项营养指标以及不良反应、并发症和格拉斯哥昏迷量表（GCS）评分、急性生理学与慢性健康状况11（APACHElI）评分等。结果两组患者经过早期肠内营养,营养指标均有改善,入院第14、28天,鼻空肠置管组患者的肱三头肌皮褶厚度、上臂肌围、血清白蛋白、前白蛋白、转铁蛋白、血红蛋白等指标上升幅度均明显高于鼻胃置管组,差异有统计学意义（P〈0．05）。鼻空肠置管组患者腹泻、腹胀、呕吐、胃内容物潴留及反流发生率明显低于鼻胃置管组[5．0％（3／60）比18．3％（11／60）、10．0％（6／60）比21．7％（13／60）、5．0％（3／60）比21．7％（13／60）、15．0％（9／60）比16．7％（10／60）、11．7％（7／60）比48．3％（29／60）、8．3％（5／60）比21．7％（13／60）],差异有统计学意义（尸〈O．05）。鼻空肠置管组并发症发生率低于鼻胃置管组[16．7％（10／60）比76．7％（46／60）],差异有统计学意义（P〈0．05）。鼻空肠置管组GCS评分、APACHEⅡ评分均较鼻胃置管组明显改善,差异有统计学意义（P〈0．05）。结论早期鼻空肠置管肠内营养对于重型颅脑损伤后亚低温状态下临床肠内营养实施是可行的、合理的,与鼻胃置管比较,能明显减少肠内营养的并发症,较早地达到目标营养治疗量,可以改善预后。     

Percutaneous endoscopic gastrostomy in the neurosurgical intensive care unit: complications and outcome

BACKGROUND: Even with a functioning gastrointestinal tract, it is not always easy to initiate oral feeding in some neurosurgical patients because of their persistently depressed neurologic status or severe lower cranial nerve palsies. Percutaneous endoscopic gastrostomy (PEG) may be required for long-term feeding in these patients. The purpose of the present study is to report our experience with PEG chosen for establishing an enteral route in patients of neurosurgical intensive care unit (ICU). METHODS: The outcome and complications of PEG in neurosurgical ICU patients of Marmara University Institute of Neurological Science between January 2001 and November 2006 were retrospectively evaluated. RESULTS: Thirty-one patients, with the median age of 51 years (range, 14-78 years) underwent PEG placement. PEG was placed before the craniotomy in 2 patients and after in 29. Indications for PEG were absent gag reflex in 10 patients and low Glasgow Coma Scale score in 21. Before the PEG tube insertion, 18 patients had enteral nutrition by a nasogastric tube and 10 had parenteral nutrition (PN), with a median duration of 14.5 (range, 4-60) and 12 (range, 7-25) days, respectively. Two patients accidentally pulled out the gastrostomy tubes 10 and 11 days after insertion. Buried bumper syndrome developed in 1 patient. Two patients died 8 and 34 days after the procedure in the neurosurgical ICU. Twenty-nine patients were discharged from the hospital while being fed via the PEG tubes. In 11 patients who were able to resume oral feeding, the tube was removed, with a median interval of 62 (range, 25-150) days. Procedure-related mortality, 30-day mortality, and overall mortality of the patients were 0%, 6.4%, and 45%, respectively. CONCLUSION: PEG is a safe and well-tolerated gastrostomy method for neurosurgical ICU patients with depressed neurologic state or severe lower cranial nerve palsies.     

胰十二指肠切除术中经胃造口管放置空肠营养管的临床研究

目的:观察胰十二指肠切除术中经胃造口管放置空肠营养管的临床疗效和病人的生存质量。方法:将25例胰十二指肠切除术病人随机分为术中经胃造口管放置空肠营养管(观察组)和传统放置胃管EN治疗(对照组),对比两组病人的手术操作时间、术后并发症、住院费用、住院时间,术后第7和第14天抑郁自评量表和焦虑自评量表评分、免疫和营养状况等指标的差异和生活质量评分(QLQ-C30)的差异。结果:观察组病人均在术中成功经胃造口管放置空肠营养管,无发生导管相关并发症,未增加手术时间、住院费用和住院时间。两组病人抑郁与焦虑评分均有显著性差异(P<0.05),术后QLQ-C30评分差异亦有显著性意义。两组病人营养状况和免疫功能指标无显著性差异。结论:胰十二指肠切除病人术中经胃造口管放置空肠营养管是安全有效的肠内营养途径,有助于提高病人的生活质量。     

Safety techniques for percutaneous endoscopic gastrostomy tube placement in Pierre Robin Sequence

Pierre Robin Sequence (PRS) is a craniofacial anomaly characterized by a triad of micrognathia, glossoptosis, and cleft palate. Infants with PRS frequently have feeding problems that may require supplemental nutrition through a nasogastric or gastrostomy tube. Very few published studies have illustrated the most appropriate method for securing an enteral feeding route in this patient population. One case report described a major complication leading to death from airway compromise following percutaneous endoscopic gastrostomy (PEG) tube placement. The authors describe a case of an infant with PRS who underwent successful PEG tube placement without complications, and they highlight certain techniques to improve procedure success and patient safety.     

早期肠内营养在大面积脑梗死病人应用的研究

目的:评价EEN对大面积脑梗死病人治疗的有效性. 方法:将61例大面积脑梗死病人随机分成EEN组和对照组.比较病人入院后3周的病死率、神经功能缺损评分、并发症发生率和营养状况等. 结果:EEN组病死率和并发症的发生率,均低于对照组,而神经功能缺损评分和营养状况优于对照组. 结论:早期给予EN,可降低大面积脑梗死病人的病死率和并发症的发生率,改善机体营养状况,促进机体神经功能恢复.