超声引导胃内注水鼻肠管置入法在ICU脑外伤患者肠内营养中的应用

目的:探讨床边超声引导下胃内注水鼻肠管置入法在ICU脑外伤患者肠内营养的安全性和有效性。方法:选取需行肠内营养的65例ICU脑外伤住院患者,采用随机数字法随机分为超声引导下胃内注水法33例,盲插法32例,比较两组患者置管当天和7 d后鼻肠管幽门通过率、置管后达到目标营养值所需时间、置管营养过程中并发症的发生率及置管营养7d后相关营养指标的差异。结果:和盲插组相比,超声引导组置管当天及7 d后的幽门通过率明显提高(28/33 vs.9/32,P<0.05;29/33 vs.11/32,P<0.05),达到目标营养值所需时间明显缩短(2.1±0.9)d vs.(3.7±1.5)d,P<0.05],置管营养过程中并发症发生率较低(P<0.05),置管7 d后相关营养指标改善明显(P<0.05)。结论:超声引导胃内注水鼻肠管置入法方便易行,可提高营养管的幽门通过率,能安全快速达到目标营养,是ICU脑外伤患者建立肠内营养通道的良好选择。

Application of enteral nutrition in patients with traumatic brain injury in ICU through nasointestinal tube water injecting in stomach by ultrasound

Objective:To explore the safety and efficacy of enteral nutrition in patients with traumatic brain injury in ICU through nasointestinal tube water injecting in stomach by ultrasound.Methods:65 cases of ICU patients with traumatic brain injuries under enteral nutrition in our hospital were selected,were randomly(number method)divided into 33 cases of stomach water injection method guided by ultrasound,32 cases of blind plug method,compare the difference of nasointestinal tube pylorus passing rate after catheter first and seventh day,required time of goal nutritional value,complication rates in the process of nutrition,nutrition index after 7 days.Results:Compared with blind plug group,pylorus passing rate after catheter first and seventh day of guided by ultrasound group improved rapidly (28/33 vs.9/32,P ＜ 0.05;29/33 vs.11/32,P ＜ 0.05),shortened the time needed for achieve nutritional value significantly (2.1 ± 0.9) d vs.(3.7 ± 1.5) d,P ＜ 0.05],reduced the complication rates (P ＜ 0.05) and enhanced nutrition index after 7 days (P ＜ 0.05).Conclusion:Nasointestinal tube water injecting in stomach by ultrasound method is convenient and easy,can improve pylorus passing rate,reach goal nutritional value quickly,is a good choice of ICU patients with traumatic brain injuries.