不同鼻饲方法对机械通气长期肠内营养老年患者误吸的影响

目的探讨采用4种鼻饲方法对机械通气长期肠内营养老年患者误吸的影响。方法对25例机械通气长期肠内营养老年患者分别采用4种鼻饲方法：①方法1：半坐卧位,置管长度从耳垂→鼻尖→剑突的距离延长10cm,推注速度为15mL/min;②方法2：仰卧位,置管长度和推注速度同方法1;③方法3：置管长度从耳垂→鼻尖→剑突的距离,卧位和推注速度同方法1;④方法4：卧位和置管长度同方法1,推注速度为25mL/min。观察采用4种方法患者误吸发生情况。结果采用4种鼻饲方法患者发生误吸情况比较,差异具有统计学意义（P〈0.01）。方法 1误吸发生率均低于其他3种方法,差异具有统计学意义（均P〈0.01）。结论鼻饲时抬高床头,推注以10～15mL/min的速度喂食,置管的长度根据患者的具体情况而定对预防机械通气长期肠内营养老年患者误吸的发生具有积极的意义。

Effects of four different nasal feeding methods on aspiration in elderly patients receiving long-term enteral nutrition with mechanical ventilation

Objective To investigate the effects of four different nasal feeding methods on aspiration in elderly patients receiving long-term enteral nutrition with mechanical ventilation. Methods Twenty five elderly patients receiving mechanical ventilation were fed for long-term enteral nutrition with 4 nasogastric feeding methods as follows： 1 ） The patient took semi-recumbent position, with the nasogastric tube inserted at the distance from the earlobe, across the tip of nose and to ensiform cartilage plus 10cm and the feeding speed of 15 mL/min; 2） The patient took supine position, with the nasogastric tube inserted at the same length and the same feeding speed as in the first method; 3） The patients took decumbent position, with the nasogastric tube inserted at the same length and the same feeding speed as in the first method; 4） The patients took the decumbent position, with the nasogastric tube inserted at the same length as in the first method but with the feeding speed of 25 mL/min. Results The differences in aspiration rates among the four methods were statistically significant （P 〈 0.01）. The aspiration rate in ihe first group was the lowest （P 〈 0.01） compared with other three methods. Conclusions The method of feeding the elderly patients at semi-recumbent position with feeding speed of 10 ~ 15 mL/min may be meaningful for preventing aspiration in mechanically ventilated elderly patients receiving long-term enteral nutrition.