Phipps Lorri M, Weber Mark D, Ginder Beth R, Hulse Michael A, Thomas Neal J
Department of Pediatrics, Division of Nursing, Penn State Children's Hospital, Penn State University College of Medicine, Hershey, PA 17033, USA.
JPEN J Parenter Enteral Nutr. 2005 Nov-Dec;29(6):420-4. doi: 10.1177/0148607105029006420.
The goal of this study was to compare 3 different techniques used to place nasojejunal (NJ) feeding tubes in the critically ill or injured pediatric patients. This was a randomized, prospective trial in a university-affiliated 12-bed pediatric intensive care unit. Patients were critically ill children requiring placement of an NJ feeding tube. Patient age, weight, medications, use of mechanical ventilation, and patient tolerance were recorded. An abdominal radiograph obtained immediately after the placement determined correct placement. The final placement was recorded, as was the number of placement attempts.
Patients were randomized to 1 of 3 groups: standard technique, standard technique facilitated with gastric insufflation, and standard technique facilitated with the use of preinsertion erythromycin. To ensure equal distribution, all patients were stratified by weight (<10 kg vs > or =10 kg) before randomization. All NJ tubes were placed by one of the investigators. If unsuccessful, a second attempt by the same investigator was allowed. Successful placement of the NJ tube was defined by confirmation of the tip of the tube in the first part of the duodenum or beyond by a pediatric radiologist blinded to the treatment groups.
Seventy-five pediatric patients were enrolled in the study; 94.6% (71/75) of tubes were passed successfully into the small bowel on the first or second attempt. Evaluation of the data revealed no significant association with a specific technique and successful placement (p = .1999).
When placed by a core group of experienced operators, the majority of NJ feeding tubes can be placed in critically ill or injured children on the first or second attempt, regardless of the technique used.
本研究的目的是比较用于在危重症或受伤儿科患者中放置鼻空肠（NJ）喂养管的3种不同技术。这是一项在一所大学附属的拥有12张床位的儿科重症监护病房进行的随机前瞻性试验。患者为需要放置NJ喂养管的危重症儿童。记录患者的年龄、体重、用药情况、机械通气的使用情况以及患者的耐受性。放置后立即获得的腹部X光片确定放置是否正确。记录最终放置情况以及放置尝试的次数。
患者被随机分为3组中的1组：标准技术组、通过胃内充气辅助的标准技术组以及通过使用插入前红霉素辅助的标准技术组。为确保均匀分布，所有患者在随机分组前按体重（<10 kg与≥10 kg）进行分层。所有NJ管均由一名研究人员放置。如果不成功，允许同一名研究人员进行第二次尝试。NJ管的成功放置由一名对治疗组不知情的儿科放射科医生确认管尖端位于十二指肠第一部或更远处来定义。
75名儿科患者纳入本研究；94.6%（71/75）的喂养管在第一次或第二次尝试时成功插入小肠。对数据的评估显示，特定技术与成功放置之间无显著关联（p = 0.1999）。
当由一组经验丰富的核心操作人员放置时，大多数NJ喂养管能够在危重症或受伤儿童中在第一次或第二次尝试时成功放置，无论使用何种技术。
