X线透视下超滑导丝辅助放置鼻空肠营养管的操作技术

目的:解决需肠内营养(EN)治疗病人的营养治疗途径问题. 方法:在既往操作经验的基础上,运用“九字诀”法行X线透视下超滑导丝辅助放置鼻空肠营养管. 结果:本组共置管162例次,成功159例次,成功率为98.15％.鼻空肠营养管放置位置符合EN治疗要求.置管时间为5～30(10.8 ±4.9)min. 结论:运用“九字诀”法行X线透视下超滑导丝辅助放置鼻空肠营养管具有无创、简单、快捷,是临床EN治疗途径首选的置管方式.     

经鼻胃镜放置鼻空肠营养管的临床应用

目的:探讨经鼻胃镜放置鼻空肠营养管的临床价值。方法:对2008年5月至2011年9月复旦大学附属中山医院内镜中心采用经鼻胃镜导丝引导下放置鼻空肠营养管进行空肠营养支持的257例病人临床资料进行回顾性分析。结果:其中256例在鼻胃镜引导下放置空肠营养管成功,成功率为99.6%,平均放置时间为8.4±4.2min。置管并发症为胃黏膜损伤18例(7.0%)和鼻黏膜出血26例(10.1%),无消化道穿孔及大出血等严重并发症,病人耐受良好。结论:经鼻胃镜放置鼻空肠营养管方法便捷,可靠,值得临床推广。     

重症急性胰腺炎病人在X线及内镜辅助下放置鼻空肠管的比较

目的:比较重症急性胰腺炎(SAP)病人在X线及内镜辅助下放置鼻空肠管的方法. 方法: 选取52例SAP病人分别采用X线辅助超滑导丝法和内镜辅助下放置鼻空肠管,记录置管成功率,置管时间,置管相关并发症的发生率,置管前、置管中、置管后舒适度(VAS评分)以及留置时间. 结果: X线辅助下超滑导丝法较内镜辅助法的置管时间短,VAS评分低,置管相关并发症(腹痛、腹胀)的发生率低(P＜0.05);两种方法在置管成功率,其他置管相关并发症(鼻咽部出血、上消化道出血、穿孔、误吸、呼吸困难)以及远期并发症(导管移位、咽炎、鼻窦炎、肺部感染)的发生率、留置时间等差异无显著性意义(P＞0.05). 结论: X线辅助下超滑导丝法和内镜辅助法均是SAP病人早期非手术放置鼻空肠管有效、安全、易行的方法.X线辅助下超滑导丝法可作为一般病人的首选方法;对需要机械通气、持续血液滤过治疗以及并发胰性脑病、十二指肠狭窄的SAP病人,内镜辅助法则更合适.     

经"T"管、胆总管、十二指肠置空肠营养管提供肠内营养

我院应用经"T"管、胆总管、十二指肠置空肠营养管的方法,成功地为1例术后胃排空障碍的病人提供肠内营养,报告如下.     

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。     

经“T”管、胆总管、十二指肠置空肠营养管提供肠风营养

我院应用经“Ｔ”管、胆总管、十二指肠置空肠营养管的方法 ,成功地为 1例术后胃排空障碍的病人提供肠内营养 ,报告如下。1　病例介绍病人女性 ,6 6岁 ,因肝内胆管结石、肝胆管癌行左半肝切除、胆囊摘除、左肝胆管空肠吻合术、肝总管置“Ｔ”管引流 ,手术顺利。术后第 5天病人肠功能恢复 ,拔除胃管进少量流质饮食 ,无不适。术后第7天病人出现上腹胀满、呕吐 ,经补充电解质、肌注胃复安等对症治疗 ,症状无改善 ,经胃肠钡餐透视 ,发现胃内有大量潴留液、胃蠕动无力、钡剂不能通过幽门 ,诊断为术后胃排空障碍 ,行胃肠减压、等渗盐水洗胃 ,补充…     

腹腔镜辅助空肠营养管置管术：新的简单空肠造口术

临床营养支持工作越来越受到医院的重视,很多大医院建立了临床营养支持中心.由临床营养支持中心专职医生开展临床营养支持工作.但在开展临床营养支持工作中,有时候必须有外科医师参加,特别是开展肠内营养支持工作.2010年3月至2013年12月笔者借用腹腔镜技术,为6例需要长期肠内营养支持的患者行微创空肠营养管置管。     

经鼻超细胃镜引导放置空肠营养管

目的观察经鼻超细胃镜在空肠营养管置入中的作用。方法对20例危重需肠内营养的患者应用FujinonEG-530N经鼻超细电子胃镜引导放置导丝至空肠，退出胃镜，沿导丝送入空肠营养管至合适位置，从另一侧鼻腔进镜，观察空肠营养管深度及是否折回。结果16例1次置管成功，4例折回，重新放置均成功。置管时间为10～45min，平均操作时间22min。平均置管深度105cm，平均留管时间14～100d。其中1例有少量鼻出血，余未出现并发症。结论经鼻超细胃镜引导放置空肠营养管较其他方法简捷、安全、实用、有效。     

急性重症胰腺炎经鼻空肠置管早期肠内营养的疗效观察

目的探讨及评价区域性动脉灌注(RAI)治疗急性重症胰腺炎(SAP)过程中,经鼻空肠置管早期肠内营养的方法及疗效。     

超声胃动力测定指导鼻空肠营养管置管的临床价值

目的:利用床旁B超改良胃窦单切面法测定胃动力指标,分析各指标与鼻肠螺旋管盲插成功之间的相关性,评价其临床预测价值. 方法:选择我院ICU收治的拟行幽门后喂养的危重症病人22例.先用改良B超胃窦单切面法分别测量病人的胃窦收缩频率(ACF)、胃窦收缩幅度(ACA)及胃窦运动指数(MI),随后经鼻盲插复尔凯(CH10-145)鼻空肠螺旋营养管.24h后行床旁X片检测确定营养管的尖端位置,以尖端达到幽门下小肠为置管成功.分析比较置管成功组与失败组之间的ACA,ACF及MI差异. 结果:①24h内导管尖端通过幽门(成功组)14例(63.60％),未通过(失败组)8例(36.40％).②成功组[ACA 0.49±0.16,ACF(3.70±2.00)次/2min]明显高于失败组[ACA 0.31±0.15,ACF(2.50 ±2.10)次/2 min],差异有显著性统计学意义(P＜0.05).③两组间MI无明显统计学差异.④ACA和ACF的ROC曲线下面积分别为0.83和0.71(P ＜0.05),MI的ROC曲线下面积为0.78(P ＞0.05). 结论:床旁超声测量ACA和ACF均可作为盲插鼻空肠营养管成功的预测指标,尤其是ACA的意义更大.     

Commercial enteral formulas and nutrition support teams improve the outcome of home enteral tube feeding

Background: The benefits of home enteral tube feeding (HETF) provided by nutrition support teams (NSTs) have been questioned recently, given the growing costs to the healthcare system. This study examined the effect of a specialized home enteral nutrition program on clinical outcome variables in HETF patients. Methods: The observational study included 203 patients (103 women, 100 men; mean age 52.5 years) receiving HETF with homemade diets for at least 12 months before starting a specialized home nutrition program for another 12 months consisting of provision of commercial enteral formulas and the guidance of an NST. Both study periods were compared regarding the number of hospital admissions, length of hospital and intensive care unit (ICU) stay, and costs of hospitalization. Results: A specialized HETF program significantly reduced the number of hospital admissions and the duration of hospital and ICU stays. The need for hospitalization and ICU admission was significantly reduced, with odds ratios of 0.083 (95% confidence interval, 0.051–0.133, P < .001) and 0.259 (95% confidence interval, 0.124–0.539, P < .001), respectively. Specialized HETF was associated with a significant decrease in the prevalence of pneumonia (24.1% vs 14.2%), respiratory failure (7.3% vs 1.9%), urinary tract infection (11.3% vs 4.9%), and anemia (3.9% vs 0%) requiring hospitalization. The average yearly cost of hospital treatment decreased from $764.65 per patient to $142.66 per year per patient. Conclusions: The specialized HETF care program reduces morbidity and costs related to long‐term enteral feeding at home.     

Small bowel feeding tube placement using an electromagnetic tube placement device: accuracy of tip location

Background: An electromagnetic tube placement device (ETPD) monitors tip position of feeding tubes (FT) during placement in the digestive tract. It helps to avoid airway misplacement and permits positioning into the small bowel (SB). This study compares the overall agreement between FT tip location as determined by an ETPD vs an abdominal radiograph of the kidneys, ureter, and bladder (KUB). Methods: Using an ETPD, A nurse placed postpyloric FTs in ICU patients. We included all patients in whom the ETPD was used for FT placement. Data were prospectively recorded for 255 days on the rate of successful postpyloric placement, ETPD estimated tip location, and KUB location. Results: 860 tubes were placed in 616 patients, 719 (83.6%) of which recorded for ETPD and KUB. According to the KUB, 81% of tubes were in the SB; however, ETPD suggested 89% were beyond the pylorus. There was moderate agreement beyond what could be attributed to chance between KUB and ETPD tip locations (475 [66.1%], κ score 0.62 [95% confidence interval 0.58–0.67]). More tubes by KUB were distal (134[18.6%]) vs proximal (110[15.3%]) to the suspected location by ETPD (P < .0001. Tubes in or distal to the second half of the duodenum, according to ETPD were rarely in the stomach (<1%). No tubes were proximal to the stomach or placed into the airway. Conclusions: The strong agreement between KUB and ETPD, when tubes were believed to be in the second part of the duodenum or beyond, suggests that KUB is necessary only when the FT tip is suspected to be in the proximal duodenum.     

The challenges of innovation in the organization of home enteral tube feeding

The number of patients discharged from hospital who need home enteral tube feeding has been increasing steadily in the UK. Arrangements for support of these patients is extremely variable. The unsatisfactory arrangements for home enteral tube feeding which existed in Avon in 1996 prompted an innovative reorganization. On the basis of that experience, this review examines the key issues involved and the questions to be considered, which may be of benefit to other trusts faced with similar challenges.     

The impact of home enteral tube feeding in everyday life: a qualitative study

Advances in clinical and technical areas, combined with developments in community support services, have enabled people to receive enteral tube feeding at home in the UK. Research has focused on clinical and technical aspects, and people's experiences have largely been explored through the audit of after-care services. The research reported in the present paper consisted of a qualitative study in which a small number of people under going enteral tube feeding at home and their carers were interviewed. The study took place in one area of northern England. The interviews explored aspects of daily life, focusing on decision-making and adaptation, and revealed positive feelings about the process of tube feeding, as well as areas of difficulty and concern. Opportunities to improve practice and services are identified from these accounts.