空肠营养管在胰十二指肠切除术后营养支持的护理体会

摘要

Objective :To explore the effect of nutrition therapy and nursing experience of jejunum nutrition tube after pancreatoduo‐denectomy .The clinical data of 35 cases of pancreatoduodenectomy between December 2006 and October 2014 were retrospectively analyzed . All cases were placed jejunum nutrition tube during the operation ,and 5 % glucose and 0 .9 % sodium chloride solution were slowly dripped through jejunum nutrition tube 12 hours after operation ,a small amount of mixture milk and soya -bean milk dripped on the second day if there was no discomfort in patients ,and compound dietary enteral nutrition solution with milk ,soybean milk ,fruit juice ,cooked meat soup dripped since the third day .Meanwhile the effect of indicators such as temperature ,concentration ,and drip speed on patients was monitored , with the postoperative curative effect observed in combination with perioperative nursing ,nutrition solution nursing ,tube nursing .Results:Nutritional support plans were completed in 35 cases ,with postoperative abdominal distension in 5 cases ,and diarrhea in 2 cases ,and all symptoms disappeared after symptomatic treatment .No complications such as biliary fistula ,pancreatic fistula occurred .The tempera‐ture of prepared nutrition solution was 37 ℃ which had no effect on infection or blocking pipe ,gradually increasing from 30 ml/h to more than 60 ml/h in dripping speed .There was low incidence of nausea ,abdominal distention ,and the reflux or falling off of the pipe didn't present under the nursing measures such as careful shift near the sickbed ,clearly marking etc .Conclusion:Accompanied with perioperative care ,dietary nutrient solution preparation ,and careful nursing measures such as pipelines nursing ,the patients with enteral nutrition support through the jejunum nutrition tube who undergo pancreatoduodenectomy recover quickly ,with low complication rate ,reduced medical cost and decreased economic burden of the patients .%目的：探讨空肠营养管在胰十二指肠切除术后的营养支持效果及护理体会。方法：回顾性分析2006年12月至2014年10月35例胰十二指肠切除术患者的临床资料，均术中留置空肠营养管，术后12 h经营养管缓慢滴入5％葡萄糖和0．9％氯化钠溶液，如无不适第2d始滴入少量牛奶、豆浆的混合液，第3d滴入含牛奶、豆浆、果汁、熟肉汤等配制膳食肠内营养液，并监测其温度、浓度、滴注速度等指标对患者的影响，结合围手术期的一般护理、营养液护理、管道护理，观察术后疗效情况。结果：35例患者均完成营养支持计划，术后出现腹胀5例、腹泻2例，对症治疗后症状均消失，无胆瘘、胰瘘等并发症的发生。所配制营养液无感染、堵管，温度37℃，滴速以30 m L／h开始逐渐增至60 m L／h以上，恶心、腹胀发生率低，通过床旁细心交班、清楚标记等护理措施管道未出现返流、脱落。结论：通过围手术期护理，膳食营养液配制、精心护理管道等措施，经空肠营养管行肠内营养的胰十二指肠切除术后患者不仅恢复快，并发症发生率低，而且降低了医疗费用，减轻了患者的经济负担。