Ferrer M, Bauer T T, Torres A, Hernández C, Piera C
University of Barcelona, Spain.
Ann Intern Med. 1999 Jun 15;130(12):991-4. doi: 10.7326/0003-4819-130-12-199906150-00007.
Little evidence exists to support the theory that small-bore nasogastric tubes prevent gastroesophageal reflux and microaspiration in intubated patients.
To determine whether gastroesophageal reflux and microaspiration in intubated patients can be reduced by the use of a small-bore nasogastric tube.
Randomized, two-period crossover trial.
Respiratory intensive care unit of a university hospital.
17 patients intubated for more than 72 hours.
Radioactive technetium colloid was instilled in each patient's stomach. Patients were studied with two nasogastric tubes (one tube with a 6.0-mm external bore and one tube with a 2.85-mm external bore) in randomized order; measurements of radioactive counts with the alternate size of nasogastric tube were repeated 72 hours after original measurements were taken. Sequential samples of serum, gastric juice, and pharyngeal and tracheal secretions were obtained.
Comparison of the time course of radioactive counting in all samples (obtained during the use of each nasogastric tube size in each patient).
The mean radioactive count of pharyngeal aspirates (P = 0.004) was greater than the baseline count at all time points, as was the cumulative radioactive count of pharyngeal aspirates 17 hours after the first dose of technetium colloid was administered (P = 0.001); however, the count of tracheal aspirates was never greater than the count at baseline. No differences were found between tube types when the time course and cumulative counts of pharyngeal and tracheal samples were compared.
Small-bore nasogastric tubes in intubated patients do not reduce gastroesophageal reflux or microaspiration.
几乎没有证据支持小口径鼻胃管可预防插管患者发生胃食管反流和微量误吸这一理论。
确定使用小口径鼻胃管是否能减少插管患者的胃食管反流和微量误吸。
随机、两阶段交叉试验。
一所大学医院的呼吸重症监护病房。
17例插管超过72小时的患者。
向每位患者胃内注入放射性锝胶体。患者按随机顺序使用两根鼻胃管（一根外径6.0毫米，另一根外径2.85毫米）；在首次测量72小时后，用另一尺寸的鼻胃管重复测量放射性计数。依次采集血清、胃液、咽部分泌物和气管分泌物样本。
比较所有样本（在每位患者使用每种鼻胃管尺寸期间采集）放射性计数的时间进程。
在所有时间点，咽抽吸物的平均放射性计数（P = 0.004）均高于基线计数，在首次注入锝胶体1个17小时后咽抽吸物的累积放射性计数也是如此（P = 0.001）；然而，气管抽吸物的计数从未高于基线计数。比较咽和气管样本的时间进程和累积计数时，未发现不同类型鼻胃管之间存在差异。
插管患者使用小口径鼻胃管并不能减少胃食管反流或微量误吸。
