超声辅助法置入经鼻空肠营养管在急性重症胰腺炎中的应用与护理

摘要

Objective To evaluate the safety and feasibility of CORPAK feeding tube placement assisted by Ultrasound in pa-tients with severe acute pancreatitis, and sum up the experience of placement.Methods 300-500 mL of normal saline was injected by gastric tube into 18 patients have severe acute pancreatitis and gastrointestinal decompression with 12 hours.The 20-9551 type CORPARK nasoenteric feeding tube was then placed into the jejunum and pass pylorus andassisted by bedside ultrasound which was not twined in the stomach and continuous push to the duodenum jejunum segment without strong resistance.The place of tube was confirned by X-ray.The patients’heart rate( HR) , respiration rate( RR) , mean arterial pressure( MAP) , central venous pressure( CVP) , oxy-gen saturation ( SpO2 ) were recorded before, during and 1 h after the procedure.Results The tube placement success rate was 94.4%and the position of tube was qualified to the requirement of enteral nutrition.The average time of tube placement was (15.0 ± 3.9) minutes.During the procedure, the patients’HR, RR and MAP increased significantly than baseline (P<0.01).The CVP and SpO2 maintained stable during the procedure (P>0.05).The patients’HR, RR, MAP recovered to baseline 1 h after the procedure. All patients safely passed through the procedure of tube placement, period of tube indwelling and enteral nutrition without serious com-plications.Conclusion The method of CORPAK feeding tube placement assisted by Ultrasound is proved to be safe, economic, tech-nically simple and high success rate for enteral nutrition without special equipment such as endoscopy and radiology.It may become one of the common methods of EN support for the treatment of severe acute pancreatitis.%目的：探讨超声辅助法置入库派经鼻空肠营养管在急性重症胰腺炎肠内营养（ eteral nutrition，EN）中应用的安全性及可行性，并总结置入经验。方法在18例重症胰腺炎患者中，预先胃肠减压12 h以上，经胃管注入300～500 mL生理盐水，置入美国库派20－9551型经鼻空肠营养管，利用床旁彩超导引下通过幽门，观察经鼻空肠营养管是否在胃内盘曲，无强阻力下持续推送直至十二指肠－空肠段，最后经X线确认置管位置。监测患者置管前、置管中及置管后1h的心率、呼吸、平均动脉压（ mean arterial pressure，MAP）、中心静脉压（ central venous pressure，CVP）以及血氧饱和度（ oxygen saturation，SpO2）的变化。结果置管成功率94．4％，操作时间（15．0±3．9）min。置管中患者出现心率、呼吸加快、MAP升高，与置管前比较，差异有统计学意义（P＜0．01），而CVP和SpO2变化无统计学意义（P＞0．05）；置管后1 h上述指标与置管前比较差异均无统计学意义（ P＞0．05）。置管、导管留置、经导管实施EN支持过程中所有患者耐受良好，未出现严重并发症。结论超声辅助法置入库派经鼻空肠营养管具有简单易行、安全、成功率高，患者耐受好等优点，不需要胃镜和放射引导等特殊设备，可作为重症胰腺炎患者EN支持治疗的常用置管方法之一。