老年长期鼻饲营养患者的并发症及护理

目的探讨老年患者长期鼻饲营养常见的并发症,制定相应的护理措施,减少并发症的发生。方法对8例老年患者鼻饲营养时出现的并发症：腹泻,胃潴留,误吸进行原因分析,主要是置管长度,鼻饲时患者的体位,注入速度、量、温度等因素。在护理过程中采取应对措施：使用恒速泵或输液管装置,保证定量点滴,少量开始,逐渐增加,温度适宜,置管长度为55～70cm,取半卧位,持续观察管饲情况及患者胃肠道反应等。结果实施有效的护理措施后,并发症减少,使鼻饲营养供给顺利进行。结论通过针对性的护理措施,可以预防和减少鼻饲营养的并发症发生。     

鼻饲置管深度与食物反流关系的探讨

目的探讨鼻饲置管深度与食物反流关系。方法95例需长期鼻饲老年患者按入院顺序分为对照组47例、观察组48例,对照组置管深度为即耳垂至鼻尖再至剑突的距离,观察组置管深度较对照组延长10 cm。结果观察组食物反流情况比对照组明显减少,差异有统计学意义。结论延长置管深度,能减少鼻饲时食物反流。     

增加留置胃管长度在儿科的应用探讨

目的探讨增加留置胃管深度对减少误吸等并发症的影响。方法将100例患儿随机分为观察者和对照组各50例。观察组置管深度为鼻尖到耳垂加鼻尖到剑突的长度,再加3~5cm置管;对照组置管深度采用传统测量方法测得的长度。观察2组置管24h内、鼻饲2h后患儿出现恶心呕吐、呛咳、反流等情况。结果观察组恶心、呕吐、呛咳、反流发生次数明显低于对照组。结论增加留置胃管深度能保证胃管所有侧孔进入胃内,从而减少反流、误吸等并发症,有效防止VAP的发生。     

脑卒中患者肠内营养误吸的相关因素分析与护理

目的探讨预防脑卒中患者肠内营养误吸发生的相关因素与预防护理措施。方法针对脑卒中鼻饲患者误吸发生的相关因素(意识状态改变、鼻饲管位置、体位不当、鼻饲管径、胃内残留量、气管切开与机械通气、输注速度、喂养量与方法),对86例患者进行临床观察与分析,采取护理措施。结果预防误吸发生的措施有保持气道通畅、妥善固定及监测胃管深度、保证准确卧位、严密监测胃内残留量、控制输入速度与输入量、定时监测气囊压力。结论严格正规操作,严密监测,严格喂养可以减少肠内营养过程中相应并发症的发生。     

脑卒中患者肠内营养误吸的相关因素分析与护理

目的 探讨预防脑卒中患者肠内营养误吸发生的相关因素与预防护理措施.方法 针对脑卒中鼻饲患者误吸发生的相关因素(意识状态改变、鼻饲管位置、体位不当、鼻饲管径、胃内残留量、气管切开与机械通气、输注速度、喂养量与方法),对86例患者进行临床观察与分析,采取护理措施.结果 预防误吸发生的措施有保持气道通畅、妥善固定及监测胃管深度、保证准确卧位、严密监测胃内残留量、控制输入速度与输入量、定时监测气囊压力.结论 严格正规操作,严密监测,严格喂养可以减少肠内营养过程中相应并发症的发生.     

老年患者鼻饲后半卧位时间与误吸的相关性研究

目的 探讨老年患者鼻饲后半卧位维持时间与误吸之间的相关性。方法 选择长期卧床、持续留置胃管长达10个月以上的患者36例,分别采取鼻饲后维持半卧位30min和维持半卧位60min各观察5个月,比较两组半卧位维持时间内误吸的发生率。 结果 鼻饲后维持半卧位60min误吸的发生率16.7%明显低于维持半卧位30min的误吸发生率38.9%（P＜0.05）。 结论 老年患者鼻饲后半卧位维持60min能很好的预防误吸的发生。     

胃镜观察分析胃肠减压置胃管深度的探讨

目的探讨有效胃肠减压的置管深度。方法通过对150例纤维胃镜观察数据分析确定胃肠减压置管深度成人为发际至剑突与鼻尖至耳垂的距离之和,并通过术中观察验证置管侧孔的位置。结果发际至剑突与鼻尖至耳垂的距离之和与门齿至胃底的距离基本相符,临床应用减压效果良好。结论成人有效胃肠减压,胃管置入长度为发际至剑突与鼻尖至耳垂的距离之和。     

新生儿洗胃插管长度的探讨

目的观察不同胃管置管长度对新生儿洗胃效果的影响。方法将201例咽下综合征患儿分为对照组和观察组,分别用传统的置管长度和鼻尖-耳垂-脐与剑突中点置管长度进行洗胃,并观察洗胃效果。结果观察组洗胃时间、残留洗胃液量、洗胃后再次呕吐率均低于对照组(P0.01)。结论新生儿咽下综合征洗胃采用鼻尖-耳垂-脐与剑突中点置管长度洗胃效果更佳,新生儿更耐受。     

机械通气患者鼻饲返流误吸预防方法的研究进展

机械通气是抢救治疗危重症患者的重要手段之一。机械通气患者不能经口进食,为了保证药物及营养的摄人,需进行肠内营养治疗。临床上机械通气患者误吸的预防多从胃管置人的方法,鼻饲方式,喂养时患者的体位,以及吸痰时机等方面施行,现对其研究近况综述如下。     

重症急性胰腺炎患者肠内营养期间误吸的预防和处理

目的探讨外科ICU重症急性胰腺炎且机械通气患者应用肠内营养期间如何降低误吸的发生率。方法对40例APACHEⅡ评分≥8分并机械通气治疗的重症急性胰腺炎患者,通过空肠管喂养途径,经肠内营养泵匀速输注营养液,取30°半卧位,气管套管气囊采用最小漏气技术,口腔护理次1／4h,及时判断有无胃潴留、腹胀、返流等误吸危险因素。结果40例行肠内营养的机械通气患者误吸发生率为7.5％;发生误吸的3例患者经及时采取纤维支气管镜灌洗,无一例死亡。结论选择经卒肠输注肠内营养的方式,定时观察误吸相关因素及时采取预防措施,可有效降低重症急性胰腺炎且行机械通气治疗患者误吸导致的吸人性肺炎的发生率。     

Decreasing aspiration risk with enteral feeding

Aspiration is a clinical concern in patients receiving enteral tube feeding. Aspiration can result in pneumonia leading to increases in the use of antibiotics, length of hospital stay, and the risk of mortality. Pneumonia caused by aspiration of gastric contents is of particular concern in patients who require mechanical ventilation and feeding by nasogastric tube. This article summarizes factors that might influence the development of aspiration pneumonia and minimize risk, such as the position of the patient's body, method of feeding, and size of the feeding tube.     

应用莫沙比利结合鼻饲体位对昏迷患者反流误吸的影响

目的 观察应用莫沙比利结合鼻饲体位对昏迷患者反流误吸的影响。 方法 将60例ICU行肠内营养的昏迷患者随机分为观察组和对照组,每组30例。2组均接受相同肠内营养制剂,采用相同卧位、鼻饲速度,观察组将莫沙比利5mg加入营养液中。 结果 观察组鼻饲患者胃内容物反流、误吸发生率低于对照组。 结论 应用莫沙必利结合鼻饲体位能有效减少昏迷患者反流误吸的发生率。     

急性呼吸窘迫综合征患者俯卧位通气时肠内营养的回顾性分析

目的分析急性呼吸窘迫综合征（ARDS）患者俯卧位通气（PPV）期间肠内营养（EN）的耐受情况。 方法收集2013年2月至2017年10月期间广州医科大学附属第一医院重症医学科60例ARDS患者的临床资料。根据患者每次PPV前后分为PPV前组及PPV组;经喂养方式分为胃管组及幽门后组;胃管组PPV期间EN速度相比每次PPV前的营养速度分为减速组及非减速组;PPV时间≥12 h为高强度PPV,根据PPV时间分为≥12 h组和≥16 h组。回顾分析各组患者行PPV治疗期间EN的情况。 结果60例ARDS患者共行321次PPV治疗,胃管组有274次,幽门后组有47次。非减速组为122次,PPV时间≥12 h有89次（72.95%）,PPV时间≥16 h有65次（53.28%）;减速组152次,PPV时间≥12 h有77次（50.66%）,PPV时间≥16 h有63次（41.45%）。胃管组在PPV治疗期间的胃残留量（GRV）、呕吐、口鼻腔可见食物残渣率和PPV前比较差异均无统计学意义（P>0.05）,即使减慢PPV期间EN速度、应用高强度PPV所得结果相近;胃管组和幽门后组的呕吐、口鼻腔可见食物差异无统计学意义（P>0.05）,但热卡摄入量低于幽门后组。 结论ARDS患者行PPV并不增加胃潴留及EN反流的风险。PPV期间不需特别减慢EN速度;对于有胃潴留或EN不达标的ARDS患者需要行PPV治疗,幽门后置管喂养是选择。     

两种肠内营养途径在口腔癌患者早期肠内营养的应用比较

目的比较经鼻肠管与经鼻胃管两种肠内营养途径在口腔癌患者实施早期肠内营养的临床应用效果,为口腔癌患者选择安全有效的肠内营养支持途径提供依据。方法将98例口腔癌患者随机分为两组,分别采取鼻肠管与鼻胃管两种途径进行肠内营养支持,比较实施两种肠内营养途径时患者并发症的发生率及住院时间。结果鼻肠管组患者的住院时间为（16.58±3.75）d,鼻胃管组为（20.02±6.42）d,两组比较,经统计学分析,t=3.271,P〈0.05,差异具有统计学意义。鼻肠管组患者并发症的发生率（10.4%）明显低于鼻胃管组（62.0%）,经统计学分析,χ2=28.039,P〈0.05,差异具有统计学意义。结论口腔癌患者实施早期肠内营养选择鼻肠管途径较选择鼻胃管途径更为安全有效。     

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

目的探讨两种不同的肠内营养方法对重症颅脑疾病患者发生返流误吸风险的差异。方法将84例需行肠内营养的ICU重症颅脑疾病患者随机分成鼻胃管组和鼻肠管组,每组各42例。两组均以鼻饲泵持续泵入肠内营养液进行营养,两组喂养72h内采集气管插管气囊上分泌物,检测胃蛋白酶含量,判断返流误吸风险。结果鼻胃管组返流的发生率明显高于鼻肠管组,差异有统计学意义（P〈0.05）。结论鼻肠管鼻饲能有效减少因胃内容物返流误吸风险。在条件允许的情况下,早期使用螺旋型鼻肠管,对重症颅脑疾病患者的预后及康复有重要意义。     

脑卒中患者胃管留置长度的循证护理实践与效果评价

目的 应用循证护理探讨脑卒中患者胃管置入长度并评价其效果。方法 将我院116例经鼻胃管肠内营养的脑卒中患者随机分为对照组（n＝52）和观察组（n＝64）,观察组根据循证步骤选取最佳的证据,改进胃管留置长度为患者眉心至脐的体表距离（约55～65 cm ）;对照组按《基础护理学》教材,胃管留置长度为患者前额发际至剑突的体表距离（约45～55 cm ）,比较两组患者返流、呛咳及误吸的发生率和胃内残留量监测情况。结果 观察组返流、呛咳及误吸发生率均低于对照组（P＜0．05）;观察组胃内残留量大于对照组（P＜0．05）。结论 采取循证护理的方法制订科学、个性化的胃管留置长度,可准确反映胃内残留量,减少返流、呛咳及误吸发生率,值得在临床实践工作中推荐。     

鼻肠管肠内营养在神经外科昏迷患者营养支持中的应用

目的探讨鼻肠管肠内营养在神经外科昏迷患者营养支持中的应用效果。方法选取神经外科手术昏迷患者78例,随机分为鼻胃管组与鼻肠管组。鼻胃管组给予鼻胃管肠内营养,鼻肠管组给予鼻肠管肠内营养,比较2组治疗前、治疗后14 d血清白蛋白(Alb)、血红蛋白(Hb)、血清前白蛋白(PAB)水平和并发症发生率。结果治疗后14 d,2组Alb、Hb、PAB水平均较治疗前明显升高(P0.05或P0.01),且鼻肠管组改善程度明显优于鼻胃管组(P0.01)。鼻肠管组并发症总发生率明显低于鼻胃管组(P0.01);2组误吸和返流发生率比较差异有统计学意义(P0.05)。结论神经外科昏迷患者经鼻肠管给予肠内营养治疗,能明显改善患者营养状况。     

Randomized comparison of nasojejunal and nasogastric feeding in critically ill patients

OBJECTIVE: Critically ill patients often develop large gastric residual volumes during nasogastric feeding as a result of poor gastroduodenal motility. Nasojejunal feeding may decrease the severity of this complication. The aim of this study was to determine whether nasojejunal feeding improved tolerance of enteral nutrition by reducing gastric residual volumes. DESIGN: Randomized, prospective, clinical study. SETTING: Intensive care unit of a university-affiliated hospital. PATIENTS: Seventy-three intensive care unit patients expected to require nutritional support for at least 3 days. INTERVENTIONS: Patients were randomized to receive enteral nutrition via a nasojejunal tube (placed endoscopically) (34 patients) or a nasogastric tube (39 patients). A strict protocol was followed, which included regular gastric residual volume measurement (in both groups), the use of predetermined criteria for intolerance, and an attempt at nasojejunal feeding for those nasogastrically fed patients who were intolerant of enteral nutrition. MEASUREMENTS AND MAIN RESULTS: Endoscopic placement of nasojejunal tubes was successful in 98% with no complications of insertion. Patients fed via a nasojejunal tube had 1) a reduced total gastric residual volume in both the first 24 (197 vs. 491 mL, p = .02) and 48 hrs (517 vs. 975 mL, p = .02); 2) a reduced incidence of a single gastric residual volume >150 mL (32% vs. 74%, p = .001); and 3) a trend toward a reduced incidence of intolerance of enteral nutrition (13% vs. 31%, p = .09). Only 13% of those nasogastrically fed patients who were initially intolerant of enteral nutrition remained intolerant once fed via a nasojejunal tube, and only 1.4% of all patients met criteria for commencement of parenteral nutrition. CONCLUSIONS: Enteral nutrition delivered via a nasojejunal tube is associated with a significant reduction in gastric residual volume, a strong trend toward improved tolerance of enteral nutrition, and an extremely low requirement for parenteral nutrition.     

Complications associated with enteral nutrition by nasogastric tube in an internal medicine unit

Enteral nutrition through a nasogastric tube is a technique often used with hospitalized patients when they present problems with oral nutrition. Patients receiving enteral nutrition show several kinds of complications such as diarrhoea, vomiting, constipation, lung aspiration, tube dislodgement, tube clogging, hyperglycaemia and electrolytic alterations. We present a prospective and observational study carried out in an Internal Medicine Unit with 64 patients who were fed by a nasogastric tube. From the results it can be seen that older people represented a majority (the average age was 76.2 years), and difficulty in swallowing was the main reason for beginning enteral nutrition. The complications which appeared were: tube dislodgement (48.5%); electrolytic alterations (45.5%); hyperglycaemia (34.5%); diarrhoea (32.8%); constipation (29.7%); vomiting (20.4%); tube clogging (12.5%); and lung aspiration (3.1%). We discuss the possible relationship between the different factors associated with the enteral nutrition procedure and the occurrence of these complications. Finally, some nursing interventions are suggested, such as: checking the gastric residue periodically; attempting to place the tube in the duodenum in unconscious patients; and the use of protective mittens in disturbed patients.     

Will nursing ICU patients in semi-recumbent positions reduce rates of nosocomial infection?

Ventilator-associated pneumonia is the main cause of ICU-acquired infection. Infection significantly increases mortality, length of ICU stay and costs (both financial and humanitarian). Ventilator-associated pneumonia is usually caused by aspiration. Ventilator-associated pneumonia risks are highest among patients who are fed through a nasogastric/orogastric tube. A semi-recumbent position reduces the risk of aspiration, so should reduce the risk of acquiring ventilator-associated pneumonia.