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床边电磁引导下危重症患者经鼻肠喂养管置管:一项单中心随机对照试验。

Bedside electromagnetic-guided placement of nasoenteral feeding tubes among critically Ill patients: A single-centre randomized controlled trial.

机构信息

Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China.

Department of Neurosurgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China.

出版信息

J Crit Care. 2018 Dec;48:216-221. doi: 10.1016/j.jcrc.2018.09.001. Epub 2018 Sep 6.

Abstract

PURPOSE

We aimed to compare the effectiveness of EM-guided and endoscopic nasoenteral feeding tube placement among critically ill patients.

MATERIALS AND METHODS

We performed a single-center, randomized controlled trial among 161 adult patients admitted to intensive care units (ICUs) requiring nasoenteral feeding. Patients were randomly assigned to EM-guided or endoscopic nasoenteral feeding tube placement (1:1). The primary end point was the total success rate of correct jejunal placement.

RESULTS

This was achieved in 74/81 and 76/80 patients who underwent EM-guided and endoscopic jejunal tube placements, respectively (91.4% vs. 95%; relative risk, 0.556; [CI], 0.156-1.980; P = 0.360). The EM-guided group had more placement attempts, longer placement time, and shorter inserted nasal intestinal tube length. However, they had shorter total placement procedure duration and physician's order-tube placement and order-start of feeding intervals. The EM-guided group had higher discomfort level and recommendation scores and lesser patient costs. This trial is registered at Chinese Clinical Trials Registry (ChiCTR-IOR-17011737).

CONCLUSION

Bedside EM-guided placement is as fast, safe, and successful as endoscopic placement and may be considered the preferred technique in critically ill patients.

摘要

目的

比较在危重症患者中,经电磁导航(EM)引导与内镜下鼻肠管置管的效果。

材料与方法

我们开展了一项单中心、随机对照试验,纳入了 161 例需接受肠内营养的 ICU 成年患者。患者被随机分配至 EM 引导或内镜下鼻肠管置管(1:1)。主要终点是正确置入空肠的总成功率。

结果

分别有 74/81 例和 76/80 例接受 EM 引导和内镜下空肠置管的患者达到了这一终点(91.4% vs. 95%;相对风险,0.556;[CI],0.156-1.980;P=0.360)。EM 引导组的置管尝试更多,置管时间更长,置入的鼻肠管长度更短。然而,其总置管操作时间和医生下置管医嘱至开始喂养医嘱的时间更短。EM 引导组的不适感评分和推荐度更高,患者费用更低。本试验已在中国临床试验注册中心(ChiCTR-IOR-17011737)注册。

结论

床旁 EM 引导置管与内镜下置管同样快速、安全且有效,可作为危重症患者的首选技术。

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