热带病与寄生虫学

热带病与寄生虫学 ›› 2015, Vol. 13 ›› Issue (2): 94-96,124.doi: 10.3969/j.issn.1672-2302.2015.02.011

• 论著 • 上一篇    下一篇

3种放置鼻空肠管方法建立重度急性胰腺炎患者肠内营养效果比较

杨怡莎，唐学军，柳堤，陆健，黎文华   

  1. 214002 江苏无锡市，南京医科大学附属无锡第二医院消化内科
  • 出版日期:2015-06-10 发布日期:2015-07-10

Comparison of the nutritional effects for patients with severe acute pancreatitis by three different nasoenteric feed tube placement

Yang Yisha, Tang Xuejun, Liu Di, Lu Jian, Li Wenhua   

  1. Department of Gastroenterology, Affiliated Second People's Hospita of Nanjing Medical University, Wuxi 214002, China
  • Online:2015-06-10 Published:2015-07-10

PDF (PC)

2071

被引次数

10

摘要： 【摘要】 目的  比较常规置管法联合促动力药物、X线辅助及内镜辅助3种方法放置螺旋型鼻空肠管建立重度急性胰腺炎患者肠内营养的效果。 方法  45例重度急性胰腺炎患者分别采用常规置管法联合促动力药物、X线辅助和内镜辅助法放置鼻空肠管建立肠内营养，每组15例。比较3组患者置管成功率和并发症发生情况、置管前、中、后舒适度（VAS评分）以及营养管平均留置时间。 结果  3种置管方法的置管成功率、置管时并发症（如鼻咽部出血、上消化道出血、穿孔，误吸、呼吸困难等）发生率、置管远期并发症（如鼻窦炎、咽炎、鼻肠管移位、肺部感染等）发生率、营养管平均留置时间差异均无统计学意义（P>0.05）。常规置管法较X线辅助法和内镜辅助法的VAS评分低（P<0.05），常规置管法的并发症发生率较低（P<0.05）。 结论  常规置管法、X线辅助法和内镜辅助法均是重度急性胰腺炎病人早期放置鼻空肠管的安全、可行方法。常规置管法可作为一般病人的首选方法，其并发症少，特别有利于后期营养支持治疗及疾病康复；对实施机械通气、持续血液滤过治疗或十二指肠狭窄、并发胰性脑病的重度急性胰腺炎病人，首选内镜辅助法。

关键词: 重度急性胰腺炎, 鼻空肠管, 肠内营养, 效果评价

Abstract:

【Abstract】 Objective  To compare the nutritional effects for patients with severe acute pancreatitis (SAP) by conventional nasoenteric feed tube placement plus gastroprokinetic agent, nasojejunal feeding tube placement guided by endoscopic or radiological assistance. Methods  A total of 45 SAP patients were included and divided into three groups by giving different tube placement described above(n=15 for each group). The three groups were compared pertaining to the success rate of tube insertion, incidence of complications, degree of comfort before, intra-and post-insertion of the feeding tube(VAS scoring) and average retention time of the tube. Results  There was no statistical difference among the three groups regarding the success rate of tube insertion, incidences of immediate and long-term complications(including nasopharyngeal bleeding, gastrointestinal bleeding, perforation, aspiration and dyspnea; pharyngitis, sinusitis, tube displacement and pulmonary infection) and average time of tube retention. However, insertion of the tube by conventional technique had lower VAS scoring and fewer complications than endoscopic or radiological assistance (P<0.05). Conclusion  Conventional nasoenteric feed tube placement and nasojejunal feeding tube placement with endoscopic or radiological assistance can be safe and reliable for patients with severe acute pancreatitis. Yet conventional tube placement should be prioritized, for it has fewer complications and favors to nutritional support and recovery, whereas endoscope-guided insertion of the feed tube is recommended for SAP patients required mechanical ventilation and continuous hemofiltration or complicated with pancreatic encephalopathy or duodenal stenosis.

Key words: Severe acute pancreatitis, Nasoenteric tube, Nasointestonal nutrition, Effect evaluation