Gabriel Sabry A, Ackermann Richard J
Department of Family Medicine, Mercer University School of Medicine, and the Medical Center of Central Georgia, Macon, Georgia 31207-0001, USA.
JPEN J Parenter Enteral Nutr. 2004 Mar-Apr;28(2):119-22. doi: 10.1177/0148607104028002119.
Enteral feeding is preferred over parenteral methods, and feeding into the duodenum is preferred over gastric feeding in certain groups of critically ill patients. However, with current techniques, feeding tubes often coil in the stomach, exposing patients to the risk of aspiration. This study investigated whether a nasoenteral feeding tube can be guided beyond the pyloric sphincter, using external magnetic guidance.
This is a case series of 288 critically ill patients who needed placement of an enteral feeding tube, carried out in the intensive care units and wards of a university-affiliated community hospital. A 12-French polyurethane nasoduodenal feeding tube was modified by placing a small magnet in the distal tip. After inserting the tube through the nares into the esophagus, an external magnet was used to draw the tube tip beyond the pyloric sphincter and further into the duodenum or jejunum. Placement was verified by plain abdominal x-ray, and the depth of insertion (stomach, proximal duodenum, distal duodenum, or jejunum) was recorded.
Three hundred twenty-nine intubations were performed in 288 patients (mean procedure time 15 minutes). In 293 cases (89.1%), the tube was placed beyond the pyloric sphincter. In 139 insertions (42.2%), the tube tip was in the distal portion of the duodenum or the jejunum. There were no significant complications.
This case series demonstrates that external magnetic guidance achieves transpyloric placement of an enteral feeding tube in 89.1% of cases. This reliable bedside technique is superior to other methods described in the literature.
在某些重症患者群体中，肠内喂养优于肠外喂养方法，且十二指肠喂养优于胃内喂养。然而，采用当前技术时，喂养管常盘绕在胃内，使患者面临误吸风险。本研究调查了使用外部磁导向能否将鼻肠喂养管引导至幽门括约肌以外。
这是一项对288例需要放置肠内喂养管的重症患者的病例系列研究，在一所大学附属医院的重症监护病房和病房进行。通过在远端尖端放置一个小磁体对一根12法式聚氨酯鼻十二指肠喂养管进行改良。将管子经鼻孔插入食管后，使用外部磁体将管尖端拉过幽门括约肌并进一步送入十二指肠或空肠。通过腹部平片验证放置情况，并记录插入深度（胃、十二指肠近端、十二指肠远端或空肠）。
对288例患者进行了329次插管（平均操作时间15分钟）。在293例（89.1%）中，管子放置在幽门括约肌以外。在139次插入（42.2%）中，管尖端位于十二指肠远端或空肠。无明显并发症。
该病例系列表明，外部磁导向在89.1%的病例中实现了肠内喂养管的经幽门放置。这种可靠的床边技术优于文献中描述的其他方法。
