Role of visual laryngoscopy and endotracheal intubation balloon deflation in nasogastric tube placement in CPR patients
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摘要: 目的 探讨可视喉镜联合气管插管气囊放气法在心肺复苏患者鼻胃管置入中的应用效果。方法 选取2020年1月—2022年12月期间，因各种原因导致心跳、呼吸骤停，送至我院急诊科要求积极救治的心肺复苏患者197例，按照鼻胃管留置方式的不同分为3组，分别以A组、B组、C组表示，以常规留置鼻胃管设为A组，常规留置鼻胃管伴气囊放气设为B组，可视喉镜留置鼻胃管伴气囊放气设为C组。3组留置过程中，均在留置鼻胃管的鼻孔同侧环状软骨水平侧面施加压力。比较3组留置的次数、最终置管成功率、所需时间、抢救操作和并发症发生率。结果 在C组中，留置鼻胃管总成功率明显高于A组和B组(97.10% vs. 68.30% vs. 78.50%，P < 0.05)。C组首次尝试成功率为87.00%(P < 0.05)，明显高于A组(28.60%)与B组(46.20%)，其中C组成功留置鼻胃管所需时间在3组中最短[(54.70±14.12)s vs. (96.30±35.38) vs. (68.65±20.61)s，P < 0.05]。且3组与留置鼻胃管所需时间呈负相关(P < 0.001，rs=-0.565)，C组所需时间最短，A组置管所需时间最长，这表明随着留置方法的改进，鼻胃管留置所需时间越短。另外与A组和B组相比，C组出现出血、盘绕和扭结等不良反应发生率最低，差异有统计学意义(分别为58.70% vs. 30.80% vs. 7.20%、33.30% vs. 24.60% vs. 4.30%、27.00% vs. 21.50% vs. 5.80%，P < 0.05)。结论 可视喉镜伴气囊放气明显提高了在心肺复苏插管患者中鼻胃管留置的首次成功率和整体成功率，并降低了出血等并发症的发生。Abstract: Objective To explore the effect of video laryngoscope and endotracheal intubation balloon deflation in nasogastric tube placement in patients with cardiopulmonary resuscitation.Methods A total of 197 CPR patients treated in the emergency department of our hospital from January 2020 to December 2022 were divided into three groups: group A, group B and group C. Routine indwelling nasogastric tube was set as group A, conventional indwelling nasogastric tube with balloon deflation as group B, and visual laryngoscopic indwelling nasogastric tube with balloon deflation as group C.In the three groups, pressure was applied at the side of the level of the annular cartilage in the nostrils of the indwelling nasogastric tube. The number of indwelling, final success rate of catheterization, time required, rescue operation, and complication rate were compared between the three groups.Results In group C, the total success rate of the indwelling nasogastric tube was significantly higher than that in groups A and B(97.10% vs. 68.30%vs. 78.50%, P < 0.05).The success rate of the first attempt in group C was 87.00%, which was significantly higher than that in groups A (28.60%) and group B (46.20%), Among the three groups, the time required for the nasogastric tube of group C was the shortest([54.70±14.12]s vs.[96.30±35.38]s vs.[68.65±20.61] s, P < 0.05).Moreover, the three groups were negatively correlated with the time required for the nasogastric tube(P < 0.001, rs=-0.565), the shortest in group C and the longest in group A, which indicated that the time required for the nasogastric tube was shorter and shorter with the improvement of the method, in addition, compared with group A and group B, group C had the lowest rate of adverse reactions such as bleeding, kink and coiling, with statistically significant differences(58.70% vs. 30.80% vs. 7.20%, 33.3% vs. 24.60% vs. 4.30%, 27.00% vs. 21.50% vs. 5.80%, P < 0.05).Conclusion Video laryngoscopy with balloon deflation can significantly improve the first and overall success rate of nasogastric tube retention in CPR intubation patients, and reduce the occurrence of complications such as bleeding.
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Key words:
- cardio-pulmonary resuscitation /
- nasogastric tube /
- air float /
- visual laryngoscope
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表 1 3组患者一般资料比较
M(Q1，Q3)，例(%) 组别 例数 性别 年龄/岁 BMI 男 女 A组 63 36(57.10) 27(42.90) 74(67, 78) 27.21(21.98, 30.12) B组 65 31(47.70) 34(52.30) 74(68, 79) 26.78(21.63, 29.12) C组 69 34(49.30) 35(50.70) 76(65, 69) 26.78(21.31, 28.84) χ2 1.313 0.526 0.555 P 0.519 0.769 0.758 组别 高血压 糖尿病 冠心病 哮喘 慢性阻塞性肺疾病 肿瘤缓解期 A组 39(61.90) 39(61.90) 30(47.60) 27(42.90) 36(57.10) 23(36.50) B组 28(43.10) 31(47.70) 23(35.40) 18(27.70) 29(44.60) 12(18.50) C组 32(46.40) 44(63.80) 22(31.90) 23(33.30) 25(36.20) 18(26.10) χ2 5.175 4.167 3.755 3.321 5.848 5.334 P 0.075 0.125 0.153 0.190 0.054 0.069 
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表 2 3组鼻胃管置管次数和胃管成功置入单次时间比较
X±S，例(%) 组别 例数 鼻胃管置管次数 鼻胃管成功置入单次时间/s 1次 2次 最终 A组 63 18(28.60) 25(39.70) 43(68.30) 96.30±35.38 B组 65 30(46.20) 21(32.30) 51(78.50) 68.65±20.61 C组 69 60(87.00) 7(10.10) 67(97.10) 54.70±14.12 χ2/F 48.268 16.051 19.042 41.942 P ＜0.001 ＜0.001 ＜0.001 ＜0.001
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表 3 3组鼻胃管留置过程中不良反应发生情况比较
例(%) 组别 例数 出血 盘绕 扭结 A组 63 37(58.70) 21(33.30) 17(27.00) B组 65 20(30.80) 16(24.60) 14(21.50) C组 69 5(7.20) 3(4.30) 4(5.80) χ2 40.495 18.212 11.063 P ＜0.001 ＜0.001 0.004
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[1] 邰春, 鲁厚清, 邵仁德, 等. 鼻肠管营养在急诊重症患者的临床研究[J]. 肠外与肠内营养, 2020, 27(1): 46-49. https://www.cnki.com.cn/Article/CJFDTOTAL-CWCN202001013.htm
[2] 王宇, 刘明, 江华. 《中国成年患者营养治疗通路指南》解读: 鼻胃管[J]. 肿瘤代谢与营养电子杂志, 2022, 9(3): 283-286. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLDX202206003.htm
[3] 张楚杰, 王璐璐, 刘玥. 血清PCT与CRP在脑卒中昏迷患者留置口咽通气道胃管合并肺部感染中的临床价值探讨[J]. 湖南师范大学学报(医学版), 2021, 18(5): 237-240. doi: 10.3969/j.issn.1673-016X.2021.05.071
[4] 靳贝贝, 龚平. 心肺复苏后机体免疫功能的变化[J]. 临床急诊杂志, 2022, 23(11): 759-763. doi: 10.13201/j.issn.1009-5918.2022.11.004 https://lcjz.whuhzzs.com/article/doi/10.13201/j.issn.1009-5918.2022.11.004
[5] Cunningham CA, Coppler PJ, Skolnik AB. The immunology of the post-cardiac arrest syndrome[J]. Resuscitation, 2022, 179: 116-123. doi: 10.1016/j.resuscitation.2022.08.013
[6] 刘国祥, 朱长清, 王世伟, 等. 心脏骤停后综合征相关急性胃肠损伤的研究进展[J]. 临床急诊杂志, 2021, 22(9): 634-640. doi: 10.13201/j.issn.1009-5918.2021.09.014
[7] 储玉倩, 张亮亮, 黄丽莎, 等. 心肺复苏相关肠道屏障损伤机制的研究进展[J]. 临床急诊杂志, 2022, 23(11): 764-769. https://lcjz.whuhzzs.com/article/doi/10.13201/j.issn.1009-5918.2022.11.005
[8] 李萍, 刘会玲, 冯俊艳, 等. 留置口咽通气道卒中昏迷患者置胃管方法比较[J]. 河北医药, 2020, 42(1): 144-146, 150. https://www.cnki.com.cn/Article/CJFDTOTAL-HBYZ202001036.htm
[9] 刘文清, 尚轶, 潘惠佳, 等. 可视喉镜在胃管置入患者中应用的Meta分析[J]. 兰州大学学报(医学版), 2020, 46(5): 8-14. https://www.cnki.com.cn/Article/CJFDTOTAL-LZYX202005002.htm
[10] 赵玉斌, 屈启才, 思永玉. 不同方法用于气管插管全麻患者术中胃管置入的比较[J]. 昆明医科大学学报, 2019, 40(8): 93-96. https://www.cnki.com.cn/Article/CJFDTOTAL-KMYX201908020.htm
[11] Ou GW, Li H, Shao B, et al. Comparison of different methods of nasogastric tube insertion in anesthetized and intubated patients: a meta-analysis[J]. World J Clin Cases, 2021, 9(26): 7772-7785. http://qikan.cqvip.com/Qikan/Article/Detail?id=7105578707
[12] Sanaie S, Mirzalou N, Shadvar K, et al. A comparison of nasogastric tube insertion by SORT maneuver(sniffing position, NGT orientation, contralateral rotation, and twisting movement)versus neck flexion lateral pressure in critically ill patients admitted to ICU: a prospective randomized clinical trial[J]. Ann Intensive Care, 2020, 10(1): 79.
[13] Lin T, Shen Y, Gifford W, et al. Methodsof gastric tube placement verification in neonates, infants, and children: a systematic review and meta-analysis[J]. Am J Gastroenterol, 2020, 115(5): 653-661. http://pubmed.ncbi.nlm.nih.gov/31464742/
[14] Rigobello MCG, Elias Junior J, Bonacim CAG, et al. Accuracy of the combined method(auscultation and pH measurement)and ultrasonography for confirmation of gastric tube placement: a study protocol for a prospective study[J]. BMJ Open, 2020, 10(9): e036033. http://bmjopen.bmj.com/content/10/9/e036033
[15] Judd M. Confirming nasogastric tube placement in adults[J]. Nursing, 2020, 50(4): 43-46.
[16] Slingerland-Boot R, Bouw-Ruiter M, van Manen C, et al. Video-assisted placement of enteral feeding tubes using the Integrated Real-Time Imaging System(IRIS)-technology in critically ill patients[J]. Clin Nutr, 2021, 40(8): 5000-5007. http://pubmed.ncbi.nlm.nih.gov/34364239/
[17] Bangarwa N, Vashishth S, Kumar V, et al. Role of endotracheal tube cuff deflation in facilitating passage of nasogastric tube[J]. Cureus, 2022, 14(9): e28668.
[18] Zhao W, Ge C, Zhang W, et al. The important role of positioning in nasogastric tube insertion in unconscious patients: a prospective, randomised, double-blind study[J]. J Clin Nurs, 2018, 27(1-2): e162-e168.
[19] Purngpipattrakul P, Petsakul S, Chatmonkolchart S, et al. Comparison of GlideScopeTM visualization and neck flexion with lateral neck pressure nasogastric tube insertion techniques in anesthetized patients: a randomized clinical study[J]. Trials, 2020, 21(1): 990. http://www.socolar.com/Article/Index?aid=200257603236&jid=200000025603
[20] Mandal M, Karmakar A, Basu SR. Nasogastric tube insertion in anaesthetised, intubated adult patients: a comparison between three techniques[J]. Indian J Anaesth, 2018, 62(8): 609-615. http://www.socolar.com/Article/Index?aid=200217917423&jid=200000065091
[21] Alizada M, Li RR, Hayatullah G. Cervical instability in cervical spondylosis patients[J]. Orthopäde, 2018, 47(12): 977-985.
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