摘要
目的探讨危重症患儿床旁胃镜引导下放置鼻空肠管进行肠内营养(EN)的安全性和有效性。方法将2019年1月至2020年4月入住河南省儿童医院ICU需要长期进行肠内营养的危重症患儿72例患儿随机分为鼻空肠管组(n=36)和鼻胃管组(n=36),鼻空肠管组患儿行床旁胃镜引导下螺旋形鼻空肠管放置,鼻胃管组采用普通鼻胃管置入,两组均进行EN。记录鼻空肠管组的置管时间、置管成功率及并发症发生率;比较两组患儿血清总蛋白(TP)、清蛋白(ALB)、前清蛋白(PA)、视黄醇结合蛋白(RBP)变化和反流、腹胀、腹泻等胃肠道并发症的发生率。结果床旁经胃镜引导下放置鼻空肠管的成功率为100%,置管时间为(21.3±9.2) min,未发生置管相关并发症。置管后7 d观察,鼻空肠管组PA(g/L:187.08±17.23 vs.164.98±16.10)、RBP(mg/L:44.12±6.92 vs.36.76±5.74)均高于鼻胃管组(P <0.05);而反流(5.6%vs.24.3%)、腹胀(2.8%vs.22.2%)并发症发生率低于鼻胃管组(P <0.05)。结论床旁胃镜引导下放置鼻空肠管进行危重症患儿EN支持治疗,具有简单、安全、快捷、并发症低及营养状态改善明显等优点,值得在临床推广应用。
Objective To evaluate the safety,efficacy of bedside endoscopic-guided placement of nasojejunal feeding tube for enteral nutrition(EN) in critically ill children. Methods 72 cases of children requiring long-term nutritional support in ICU from January 2019 to April 2020 were randomly divided into nasojejunal tube feeding group(n = 36) and nasogastric tube feeding group(n =36). The nasojejunal feeding group were placed nasojejunal feeding tube with assist of endoscope at the bedside;the other group were placed nasogastric tube. Patients were all given EN support. The catheter placement time,successful rate and complication rate were recorded. The levels of serum total protein(TP),albumin(ALB),prealbumin(PA) and retinol-binding protein(RBP) were detected. The incidence of reflux,abdominal distension and diarrhoea were observed in the two groups. Results The successful rate of bedside nasojejunal tube placement by endoscope was 100. 0% and catheter placement time was(21. 3 ± 9. 2) min with no adverse reaction. Seven days after nutritional support,the blood index of the nasojejunal tube feeding group[PA(187. 08 ± 17. 23) g/L,RBP(44. 12 ± 6. 92) mg/L]were increased than those of the nasogastric tube feeding group[PA(164. 98 ± 16. 10) g/L,RBP(36. 76 ±5. 74) mg/L,P < 0. 05];and the incidences of reflux and abdominal distension were significantly lower in nasojejunal tube feeding group than in nasogastric tube feeding group(5. 6% vs. 24. 3%,2. 8% vs.22. 2%,P < 0. 05). Conclusion Nasojejunal feeding tube with assist of endoscope at the bedside is placed for EN support treatment of critically ill children,which is simple,safe,effective and practical.It is a good choice for establishing EN channel in critically ill children.
作者
周方
王瑞锋
李素丽
李小芹
Zhou Fang;Wang Rui-feng;Li Su-li;Li Xiao-qin(Department of Digestion,Henan Children's Hospital(Zhengzhou Children's Hospital,Childrens Hospital Affiliated to Zhengzhou University),Zhengzhou 450053,China)
出处
《中国急救医学》
CAS
CSCD
2021年第1期37-40,共4页
Chinese Journal of Critical Care Medicine
基金
河南省医学科技攻关项目(201702324)。
关键词
肠内营养(EN)
危重症
鼻空肠管
床旁放置
Enteral nutrition(EN)
Critical illness
Nasojejunal feeding tube
Bedside placement
