气管切开患者鼻饲时发生反流误吸的原因及体位摆放

目的 分析气管切开患者鼻饲时发生反流误吸的原因，并探讨体位摆放对预防反流误吸的效果。方法 选择80例患者，随机分为两组，各40例，对照组保持患者仰卧位，并注意调节胃管深度，鼻饲速度，避免剧烈吸痰等，观察组则将患者仰卧位改为头高脚低30°的斜坡卧位，在鼻饲（进食）前15分钟尽量避免吸痰，鼻饲（进食）后30分钟保持斜坡卧位，避免改变体位及翻身拍背等操作，比较两组患者发生呛咳、反流、误吸的比率及鼻饲期间患者的生命体征变化情况。结果 观察组发生呛咳、反流、误吸的比率均显著低于对照组（P〈0.05），在鼻饲（喂养）后30（15）min、1h（30min）和2（1）h，观察组患者胃内回抽留置量均显著少于对照组（P〈0.05），观察组呼吸频率少于对照组（P〈0.05），且血氧饱和度高于对照组（P〈0.05）。结论 对于气管切开患者进行鼻饲时采用头高脚低30°斜坡卧位能加快胃排空，有效减少发生呛咳、反流误吸等并发症，更有利于患者生命体征的维持。关键词] 气管切开；鼻饲；反流误吸；原因；体位

The reasons of regurgitation and attracts by mistake of tracheotomy pa- tients with nasogastric feeding and placed in position

Objective To analyze the reasons of regurgitation and attracts by mistake of tracheotomy patients with nasogastrie feeding and discuss the placed in position on the prevention of regurgitation and attracts by mistake. Methods 80 eases were selected and randomly divided into two groups,with 40 cases in each group,the control group were keep the patient with supine,payed attention to adjust the depth of the tube and feeded speed,avoided vigorous suctioning, etc.,then observation group with supine slope lying of head high with 30~ and used the supplied bracket properly esti- mated that in 15 minutes to avoid suction,and keep slopes lying to avoid changes in position and stand back operation within 30 min after nasogastric feeding,then the rates of cough,regurgitation,aspiration during nasogastric feeding and the changes of the patient＇s vital signs were compared. Results The rates of chok,reflux, attracts by mistake in obser- vation group were lower than that of control group （P〈0.05）,after the nasogastric feeding 30 min,1 h and 2 h,the obser- vation group retraced indwelling stomach were less than that of control group （P〈0.05）,respiratory rate was lower and the oxygen saturation was higher than that of control group（P〈0.05）. Conclusion The use of supine slope lying of head high with 30 o for plugging tracheotomy patients with nasogastric feeding can accelerate gastric emptying and reduce the risk of choking,regurgitation and aspiration and other complications,so it is more advantageous to mainten the pa tients＇ vital signs.