Haslam Derrick, Fang John
Division of Gastroenterology, University of Utah Health Sciences Center, Salt Lake City, Utah 84132-2410, USA.
Curr Opin Clin Nutr Metab Care. 2006 Mar;9(2):155-9. doi: 10.1097/01.mco.0000214575.76848.b7.
Enteral nutrition is the preferred route for nutrition support in the intensive care unit setting. This is usually delivered through nasoenteric feeding tubes in patients with an otherwise functional gastrointestinal tract. Placement of nasoenteric feeding tubes, however, may be difficult in this setting. Nasoenteric feeding tubes may be placed by multiple methods, each with their particular advantages and disadvantages. This review summarizes the recent literature on different methods of nasoenteric feeding tube placement with emphasis on critically ill patients.
Bedside assisted methods using electromyogram, electrocardiogram, and magnetic fields to provide immediate positional feedback to help guide tube advancement appear promising. Bedside methods using specific protocols, modified feeding tubes, prokinetics or magnetic assistance were also successfully reported. None of these methods has been prospectively compared with more commonly practiced methods in large studies. Endoscopic nasoenteric tube placement methods including transnasal approaches using ultra-thin endoscopes have been recently described and appear to be equivalent to fluoroscopic placement. All these recently reported techniques, however, may require more specialized equipment or training than is currently widely available.
Feeding tubes can be placed using bedside, fluoroscopic, and endoscopic means. Novel bedside methods have been recently described using immediate positional feedback or new assistive methods. Endoscopic techniques have similar success rates to fluoroscopic techniques and provide data on upper gastrointestinal abnormalities. There is no clear universal standard method. When feeding tube placement is required the technique used depends on local institutional resources and expertise.
肠内营养是重症监护病房营养支持的首选途径。对于胃肠道功能正常的患者，通常通过鼻肠饲管进行。然而，在这种情况下放置鼻肠饲管可能会有困难。鼻肠饲管可通过多种方法放置，每种方法都有其独特的优缺点。本综述总结了近期关于鼻肠饲管不同放置方法的文献，重点关注危重症患者。
使用肌电图、心电图和磁场的床边辅助方法，可提供即时位置反馈以帮助引导饲管推进，看起来很有前景。也有成功报道使用特定方案、改良饲管、促动力药或磁辅助的床边方法。在大型研究中，这些方法均未与更常用的方法进行前瞻性比较。最近描述了包括使用超薄内镜经鼻途径在内的内镜下鼻肠管放置方法，其似乎与荧光镜引导放置效果相当。然而，所有这些最近报道的技术可能需要比目前广泛可用的设备更专业的设备或培训。
饲管可通过床边、荧光镜引导和内镜等方式放置。最近描述了使用即时位置反馈或新辅助方法的新型床边方法。内镜技术与荧光镜技术的成功率相似，并能提供上消化道异常情况的数据。目前尚无明确的通用标准方法。当需要放置饲管时，所使用的技术取决于当地机构的资源和专业知识。
