一种新的空肠营养管置入方法

目的探讨鼻胆引流管经结肠镜附件管道置入空肠行肠内营养的安全性以及有效性。方法回顾性分析华中科技大学同济医学院附属协和医院2013至2017年间120例经内镜放置空肠营养管病人的临床资料,其中80例病人为经结肠镜活检孔钳道置入鼻胆引流管至空肠(简称鼻胆管组),另40例病人为胃镜下异物钳夹持螺旋胃管法(简称螺旋胃管组)。结果120例病人均全部成功置入营养管于空肠上段并顺利行肠内营养;病人在置管过程中耐受性良好,所有病人均一次放置成功。螺旋胃管组比鼻胆管组:置管时间为15~60min比5~30min,平均30min比15min;平均置管深度为(95±10)cm比(120±10)cm;置管后所有病人对肠内营养耐受良好,病人营养状况得到明显改善,无因不适或不能耐受留置营养管而需拔管者;无一例出现穿孔、消化道出血及腹痛等并发症。结论鼻胆引流管经结肠镜附件管道置入空肠行肠内营养的方法较胃镜下异物钳夹持螺旋胃管法具有时间短和置管更深的优点,同时也具备创伤小、易操作、安全性和成功率高等特点,同时便于护理,病人易于接受,值得临床医师推广使用。

Clinical application of naso biliary drainage tube in jejunal enteral nutrition via colonoscopy

Objective To investigate the safety and efficacy of enteral nutrition through jejunal drainage tube via colonoscopy. Methods The clinical data of 120 patients who underwent endoscopic placement of jejunal feeding tube from 2013 to 2017 in Union Hospital, Tongji Medical College of Huazhong University of Science and Technology were analyzed retrospectively. Among them, 80 patients received endoscopic placement of nasobiliary drainage tube to jejunum via biopsy channel (referred to as nasobiliary tube group), and the other 40 patients received gastroscopy-guided foreign body clamping spiral gastric tube method (referred to as spiral gastric tube group). Results All 120 patients were successfully placed feeding tube in the upper jejunum and enteral nutrition was successfully performed. Spiral gastric tube group vs. nasobiliary tube group: the catheterization time was 15-60 min vs. 5-30 min, with an average of 30 min vs. 15 min, and the average catheterization depth was (95±10) cm vs.(120±10) cm;after catheterization, all patients were well tolerated for enteral nutrition, and their nutritional status was significantly improved. None of them needed to be extubated due to discomfort or intolerance of indwelling nutrition tube;none of them had complications such as perforation, gastrointestinal bleeding and abdominal pain. Conclusion The method of enteral nutrition with nasobiliary drainage tube inserting jejunum through the accessory duct of colonoscopy has the advantages of less trauma, shorter time and deeper catheterization than the method of gastroscopy-guided clamping spiral gastric tube with foreign body. It also has the characteristics of less trauma, easy operation, safety and high success rate. It is also convenient for nursing and easy for patients to accept. It is worthy of being widely used by clinicians.