改良徒手法幽门后置管在老年危重症患者中的应用研究-东南大学学报医学版

改良徒手法幽门后置管在老年危重症患者中的应用研究

单位：南京市中心医院重症医学科, 江苏南京 210018

分类号：R459.3

出版年·卷·期（页码）：2019·38·第一期（81-84）

摘要：

目的：探讨在老年危重症患者中改良徒手法幽门后置管建立肠内营养途径的应用价值。方法：选择2015年12月至2017年11月我院ICU需行幽门后营养的老年患者共35例，采用改良库派流程行徒手幽门后营养管置管术。（1）进入胃之前采用撤除引导钢丝，仅导管经鼻置入，减少粘膜损伤及误入气道机会。（2）进入胃内后，调整患者至右侧卧位，匀速缓慢置入导管，无较大阻力下，不回抽导丝，直至导管至75 cm后，再行回退导丝及回抽、注气等判断。结果：本组35例徒手法行幽门后置管，成功32例，成功率91.4%，其中一次置管成功30例，成功率85.7%。平均置管时间（17.54±7.23）min，置管深度（106.86±4.21）cm。结论：改良徒手法幽门后营养管置管法具有成功率高、并发症极少等优点，在老年危重症患者中有应用推广价值。

Objective:Evaluate the effectiveness of open-hand post-pyloric feeding tubes in elderly patients with critical disease. Methods:Patients who underwent post-pyloric feeding tube insertion from December, 2007, to November, 2011, were included in the study. An improved Kupa procedure was used for the operation of post-pyloric nutrition tube placement. (1) Before entering the stomach, the guide wire was removed, only the catheter was inserted through the nose to reduce the mucosal injury and the chance of entering the airway by mistake. (2) After entering the stomach, the patient was adjusted to the right lateral position, and the catheter was placed slowly and uniformly, without resistance. The guide wire was not pulled back until the catheter was inserted for 75cm, and then pumping gas injection for judgment. Results:Among the 35 cases, 32 cases were successfully placed with pylorus, and the success rate was 91.4. Among them, 30 cases were successfully placed in one time, and the success rate was 85.7% with a mean insertion time (17.54±7.23) min, depth (106.86±4.21) cm. Conclusion:Open-hand post-pyloric feeding tube insertion is simple, feasible, and suitable for elderly patients with critical disease.

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