X线下胃空肠联合置管肠内营养安全性和有效性研究

目的评价X线辅助下联合放置鼻空肠营养管、鼻胃管在危重症早期胃肠道管理中的安全性、有效性。方法选择17例不能经胃直接肠内营养的早期危重病患者，在X线辅助下将带有金属导丝的鼻空肠营养管置入空肠，再将鼻胃管自对侧鼻腔置入胃内减压引流行早期肠内营养。结果X线下可将鼻空肠营养管放置至Treitz韧带30cm以远的空肠部位和将带有金属导丝的鼻胃管置入胃部，置管成功率100％，置管时间24-52min，平均（35±10.6）分钟，置管后导管在位良好，喂养及引流过程顺利，空肠管留置时间7-21天，平均（14±6.5）天，发生鼻窦炎1例，余无明显并发症发生。结论x线下联合放置鼻空肠营养管、鼻胃管是一种操作简便、快捷、安全、有效的置管技术，对危重症患者早期胃肠道管理提供了一种更为有效的方法。

enteral nutritional support with combination of fluoroscopically naso -enteric tube and naso -gastric tube in critically ill patients under X ray

Objective To evaluate the validity and safety of placing naso-jejunal tube combined with naso-gastric tube with auxiliary orientation by X Ray in early gastrointestinal tract management in severe petients.Methods 17 severe patients who cannot accept direct enteral nutrition during earlier period,with auxiliary orientation by X Ray,the early enteral nutrition was performed with naso-jejunal tube with wire guide inserted into jejunum,and nasogastric tube inserted into stomach for decompression and draining.Results With auxiliary orientation by X Ray,the location of cusp of the feeding tube was 30cm beyond Treitz ligament suitable for enteral nutrition,the naso-gastric tube with wire guide can be inserted into stomach easily.The tube was in the good position,feeding and draining,were successfully.The success ratio was 100% and the time of placing tube was from 24 to 52(35±10.6) min and the indwelling time of the tube was from 7 to 21(14±6.5)d.Sinusitis was found in 1 case.Other discomfort and complications were not noted during the placement and use of the naso-intestinal feeding tube in other patients.Conclusion Auxiliary Orientation by X Ray,the placing of combination of naso-jejunal tube and naso-gastric tube is the safety,effective convenient and shortcut,and that provide a effective method for the early gastrointestinal trac administration in severe patients.