Department of Neurosurgery, Harrison International Peace Hospital Attached to Hebei Medical University, Hengshui City, Hebei Province, China.
J Clin Nurs. 2018 Jan;27(1-2):e162-e168. doi: 10.1111/jocn.13898. Epub 2017 Nov 8.
To investigate whether positioning the body in a lateral decubitus position will facilitate nasogastric tube insertion in unconscious patients.
Inserting a nasogastric tube into unconscious patients can be challenging because these patients cannot cooperate with the operator. The piriform sinus and arytenoid cartilage are the most commonly reported impaction sites. However, we found that the first impaction site was the backward displaced tongue when inserting a nasogastric tube in unconscious patients who often exhibited glossoptosis. Performing an intubation in the lateral decubitus position could make this procedure easy.
This prospective, double-blind, parallel, randomised controlled trial was conducted in Hengshui City, Hebei Province, China.
A total of 110 cases of unconscious patients were enrolled. The patients were randomly assigned to a conventional group (group C) or a lateral decubitus position group (group L). In group C, the nasogastric tube was inserted while the patients were in a supine position using the conventional technique, and in group L, the tube was inserted in a lateral decubitus position or further tilting the body to a prone decubitus position 20-30°. We discussed reasonable intubation methods in unconscious patients by comparing the success rate on first insertion, the overall success rate, the intubation time and the complication rates between the two groups.
Group L had a higher success rate on first insertion and overall success rate than group C (p < .05). The intubation time in group L was shorter than that in group C (p < .001), and the complication rate in group L was lower than that in group C (p < .05). The differences were statistically significant.
The backward displaced tongue blocks the pharyngeal passage. Nasogastric tube insertions in the lateral decubitus position are recommended in unconscious patients because of the higher success rate, reduced intubation time and lower complication rate.
This study provides an effective method for nasogastric tube insertions in unconscious patients.
研究将患者置于侧卧位是否有助于在无意识患者中插入鼻胃管。
在无意识患者中插入鼻胃管可能具有挑战性，因为这些患者无法配合操作者。梨状窦和杓状软骨是最常报告的嵌塞部位。然而，我们发现当在经常出现舌后坠的无意识患者中插入鼻胃管时，第一个嵌塞部位是向后移位的舌头。在侧卧位进行插管可以使这一过程变得容易。
这是一项在中国河北省衡水市进行的前瞻性、双盲、平行、随机对照试验。
共纳入 110 例无意识患者。患者被随机分配到常规组（C 组）或侧卧位组（L 组）。在 C 组中，使用常规技术将患者置于仰卧位时插入鼻胃管，在 L 组中，将管插入侧卧位或进一步将身体倾斜至俯卧位 20-30°。我们通过比较两组患者首次插入成功率、总体成功率、插管时间和并发症发生率，讨论了在无意识患者中合理的插管方法。
L 组首次插入成功率和总体成功率均高于 C 组（p<0.05）。L 组的插管时间短于 C 组（p<0.001），L 组的并发症发生率低于 C 组（p<0.05）。差异具有统计学意义。
向后移位的舌头阻塞了咽道。建议在无意识患者中采用侧卧位插入鼻胃管，因为其成功率更高、插管时间更短、并发症发生率更低。
本研究为无意识患者的鼻胃管插入提供了一种有效的方法。
