Emergency and Critical Care Center, Intensive Care Unit, Affiliated People's Hospital, Zhejiang Provincial People's Hospital, Hangzhou Medical College, No. 158 Shangtang Road, Gongshu District, Hangzhou, 310014, Zhejiang Province, China.
The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang Province, China.
BMC Gastroenterol. 2024 Aug 23;24(1):284. doi: 10.1186/s12876-024-03363-z.
Patients in the intensive care unit (ICU) are highly susceptible to malnutrition, and while enteral nutrition via nasogastric tube is the preferred method, there is a risk of inadvertent reflux and aspiration. Therefore, clinicians have turned to nasointestinal tubes (NET) for enteral nutrition as an alternative option. But the precise localization of NET presents an ongoing challenge. We proposed an innovative approach to provide a valuable reference for clinicians involved in NET placement.
Data were obtained retrospectively from the medical records of adult patients with a high risk of aspiration or gastric feeding intolerance who had a NET placed in the ICU of Zhejiang Provincial People's Hospital between October 1, 2017, and October 1, 2023. The collected data were subjected to statistical analysis using SPSS and R software.
There were 494 patients who met the inclusion and exclusion criteria. The first-pass success rate was 81.4% (n = 402). The success of a patient's initial NET placement was found to be associated with Angle SPC and Distance CP, as determined by univariate analysis (25.6 ± 16.7° vs. 41.9 ± 18.0°, P < 0.001; 40.0 ± 26.2 mm vs. 62.0 ± 31.8 mm, P < 0.001, respectively). By conducting a multivariate regression analysis, we identified a significant association between pyloric types and the success rate of placing NET (OR 29.559, 95%CI 14.084-62.038, P < 0.001).
Angle SPC, Distance CP, and the type of pylorus are independently associated with successful initial placement of NET. Besides, patients with the outside type of pylorus (OP-type) exhibit a higher rate of initial placement success.
重症监护病房（ICU）中的患者极易出现营养不良，而经鼻胃管进行肠内营养是首选方法，但存在意外反流和误吸的风险。因此，临床医生转而使用鼻肠管（NET）作为肠内营养的替代选择。但是，NET 的精确定位仍然是一个持续存在的挑战。我们提出了一种创新方法，为参与 NET 放置的临床医生提供有价值的参考。
从 2017 年 10 月 1 日至 2023 年 10 月 1 日期间在浙江省人民医院 ICU 中因误吸风险高或胃饲不耐受而接受 NET 放置的成人患者的病历中回顾性地获取数据。使用 SPSS 和 R 软件对收集的数据进行统计分析。
符合纳入和排除标准的患者有 494 例。初次 NET 放置的一次成功率为 81.4%（n=402）。单因素分析显示，患者初次 NET 放置的成功率与 Angle SPC 和 Distance CP 有关（25.6±16.7° vs. 41.9±18.0°，P<0.001；40.0±26.2mm vs. 62.0±31.8mm，P<0.001）。通过多变量回归分析，我们发现幽门类型与 NET 放置成功率之间存在显著关联（OR 29.559，95%CI 14.084-62.038，P<0.001）。
Angle SPC、Distance CP 和幽门类型与 NET 的初次成功放置独立相关。此外，幽门外型（OP 型）患者的初次放置成功率更高。
