Effect of ultrasound guided-indwelling nasointestinal tube for enter nutrition support in patients with respiratory failure undergoing mechanical ventilation
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摘要: 目的:探讨急诊呼吸衰竭机械通气患者鼻空肠管留置给予肠内营养 (EN) 实施疗效。方法:选择北京友谊医院急诊ICU 2017-09-2018-08期间收治的50例发生呼吸衰竭需气管插管行机械通气的患者, 按随机数字表法分为行鼻空肠管留置组 (试验组) 和行鼻胃管留置组 (对照组), 每组25例。分别于治疗前和治疗后7、14d观察并比较两组白蛋白 (ALB)、前体白蛋白 (PA)、血红蛋白 (Hb)、机械通气 (MV) 和住院时间, 以及呼吸机相关肺炎 (VAP) 和反流误吸、胃潴留等并发症的发生率。结果:两组病例在治疗前年龄、ALB、PA、Hb和病情严重度 (通过APACHEⅡ评分) 等方面差异无统计学意义, 具有可比性。①营养指标:治疗7、14d时, 试验组ALB、PA、Hb高于对照组[7dALB (g/L):(25.8±4.0) vs. (23.9±3.6), PA (g/L):(0.20±0.07) vs. (0.17±0.06), Hb (g/L) (99.6±20.6) vs. (97.8±19.8);14dALB (g/L):(31.7±3.9) vs. (29.8±3.5), PA (g/L):(0.21±0.06) vs. (0.17±0.03), Hb (g/L):(100.5±20.3) vs. (96.5±19.6), 均P＜0.05]。②试验组患者并发症发生率明显低于对照组[16% (4/25) vs.48% (12/25), P＜0.05]。③试验组患者MV时间、住EICU时间和住院时间均较对照组明显缩短[MV时间 (d):(11.0±1.6) vs. (14.8±2.4), 住EICU时间 (d):(13.1±1.8) vs. (18.6±2.7), 住院时间 (d):(25.2±2.5) vs. (31.5±2.8), 均P＜0.05];试验组患者VAP的发生率较对照组减少[24% (6/25) vs.36% (9/25), P＜0.05]。结论:对于急诊呼吸衰竭机械通气患者鼻空肠管留置给予肠内营养支持不仅能早期尽快改善患者营养状况, 减低胃潴留等并发症的发生率, 还能缩短机械通气时间, 降低呼吸机相关肺炎发生率, 缩短病程, 提高患者生存质量。Abstract: Objective: To evaluate the effect of ultrasound guided-indwelling nasointestinal tube for enter nutrition support in patients with respiratory failure undergoing mechanical ventilation.Method: A total of 50 respiratory failure patients undergoing mechanical ventilationadmitted to emergency intensive care unit of emergency department of Beijing Friendship Hospital from September 2017 to August 2018 were enrolled, and they were divided into nasogastric tube group in which the EN was fed by nasogastric tube and nasal jejunal feeding tude ground by random digits table, with 25 patients in each group.Albumin (ALB) precursor albumin (PA) hemoglobin (Hb) before and 7 days, 14 days after treatment, duration of MV, hospitalization time, and incidences of ventilator-associated pneumonia (VAP) and reflux wrong aspiration gastric retention of the two groups were observed and compared.Result: There was no statistically significant difference in ALB、PA、Hb and APACHEⅡ score before treatment between the two groups.①Seven days and fourteen days after treatment, ALB PA Hb were significantly higher than those in nasogastric tube group[seven days ALB (g/L):25.8±4.0 vs.23.9±3.6, PA (g/L):0.20±0.07 vs.0.17±0.06, Hb (g/L) 99.6±20.6 vs.97.8±19.8;fourteen days ALB (g/L):31.7±3.9 vs.29.8±3.5, PA (g/L):0.21±0.06 vs.0.17±0.03, Hb (g/L) 100.5±20.3 vs.96.5±19.6].②The complication rate in nasointestinal tube group was obviously lower than that in nasogastric tube group[16% (4/25) vs.48% (12/25), P＜0.05].③Duration of MV、EICU time and hospitalization time in nasointestinal tube group was obviously less than that in nasogastric tube group.[MV time (d):11.0±1.6 vs.14.8±2.4, EICU time (d) 13.1±1.8 vs.18.6±2.7, hospitalization time (d) 25.2±2.5 vs.31.5±2.8 (both P＜0.05)].④The VAP rate in nasointestinal tube group was obviously lower than that in nasogastric tube group[24% (6/25) vs.36% (9/25) (P＜0.05)].Conclusion: For patients with respiratory failure undergoing mechanical ventilation, enter nutrition support treatment by ultrasound guided-indwelling nasointestinal tube is helpful for improvement of nutritional indexes reduction of complications such as gastric retention VAP rate, etc.shortening the time of MV and shortening the course of disease, thus the method can obviously promote the patients quality of life.
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