不同体位与方式鼻饲患者口咽及支气管分泌物胃蛋白酶含量的变化

目的观察采用不同体位与方式鼻饲时，创伤后昏迷患者口咽及支气管分泌物胃蛋白酶含量的变化，探讨其对鼻饲后反流与误吸的影响。方法采用正交试验设计，对27例创伤后昏迷患者在不同床头高度、卧位、鼻饲速度及鼻饲量条件下进行鼻饲，分别在计时1h、2h后收集患者口咽及支气管分泌物，测定其中胃蛋白酶的含量。结果不同床头高度时，患者口咽分泌物在计时1h、支气管分泌物在计时1h和2h后胃蛋白酶的含量有显著性差异。不同鼻饲速度时，患者口咽分泌物在计时1h和2h、支气管分泌物在计时2h后胃蛋白酶的含量有显著差异。结论床头抬高30°、左侧卧位、鼻饲速度10ml／min时口咽反流或误吸最少，而不同鼻饲量对口咽反流及误吸无明显影响。

Changes of Pepsin Contents in Orophsryngeal and Bronchial Secretions in Patients Receiving Tube Feeding at Different Positions or Using Different Methods

Objective To study the changes of pepsin contents in orophsryngeal and bronchial secretions in trauma patients receiving tube feeding at different positions or using different methods, and to assess their influence on regurgitation and aspiration after tube feeding. Methods The orthogonal designing was adopted in the present study. Twenty-seven traumatic coma patients received tube feeding at different head angles, recumbent positions, speeds, and with different ：volumes of foods. Oropharyngeal and bronchial secretions were harvested at 1 h and 2 h to detect the pepsin contents. Results Different head angles resulted in different contents of pepsin in the oropharyngeal secretions 1 h later and in the bronchial secretions 1 h and 2 h later. Different feeding speeds led to different pepsin contents in oropharyngeal secretions 1 h and 2 h later and in bronchial secretions 2 h later. Conclusion Minimum reflux and aspiration are found when the head angle is at 30°, when at left recumbent positions, and when at a feeding speed of 10 ml/min.