Rees R G, Payne-James J J, King C, Silk D B
Department of Gastroenterology and Nutrition, Central Middlesex Hospital, London, England.
JPEN J Parenter Enteral Nutr. 1988 Sep-Oct;12(5):469-72. doi: 10.1177/0148607188012005469.
Certain groups of patients requiring enteral nutritional support are at increased risk of regurgitation and pulmonary aspiration of feed. Positioning of enteral feeding tubes distal to the pylorus has been advocated as a method of reducing such complications. Various techniques have been suggested to achieve postpyloric siting. Reports have indicated that lengthening the tube or altering the distal end tip configuration, by varying the tip profile or by the addition of a weight, may facilitate spontaneous transpyloric passage of the tube. This prospective controlled clinical study using three new polyurethane tubes demonstrates that the frequency of spontaneous transpyloric passage of the tube is not affected by tip profile or by the addition of a weight. Indeed, with all three tube designs only about one-third had passed spontaneously through the pylorus at 24 hr. Once through the pylorus the unweighted tube stayed in position significantly longer than the weighted tubes (p less than 0.005). We suggest that in those patients requiring post-pyloric feeding, endoscopic or fluoroscopic techniques should be used to position the tubes at the time of insertion, and that an unweighted tube should be used to prolong tube usage.
某些需要肠内营养支持的患者群体发生喂养反流和肺部误吸的风险增加。将肠内喂养管置于幽门远端已被提倡作为一种减少此类并发症的方法。人们提出了各种技术来实现幽门后定位。报告表明，通过改变尖端外形或增加重量来延长管子或改变远端尖端形状，可能有助于管子自发通过幽门。这项使用三种新型聚氨酯管的前瞻性对照临床研究表明，管子自发通过幽门的频率不受尖端外形或增加重量的影响。事实上，对于所有三种管型设计，在24小时时只有约三分之一的管子自发通过了幽门。一旦通过幽门，无加重物的管子比有加重物的管子在位时间显著更长（p<0.005）。我们建议，对于那些需要幽门后喂养的患者，应在插入时使用内镜或荧光镜技术来定位管子，并且应使用无加重物的管子来延长管子的使用时间。
