Spain D A, DeWeese R C, Reynolds M A, Richardson J D
Department of Surgery, University of Louisville School of Medicine, Kentucky 40292, USA.
J Trauma. 1995 Dec;39(6):1100-2. doi: 10.1097/00005373-199512000-00015.
Early enteral nutrition is reported to improve outcome of patients with severe closed head injuries (CHI). The efficacy and safety of nasoenteric tube (NET) feeds, however, has been questioned; the risk of aspiration is the major concern. Our purpose was to determine the rate of transpyloric migration, the efficacy of adjunctive measures to promote passage, and the effect on pulmonary complications. Seventy-four consecutive patients with moderate to severe CHI received enteral nutrition. Glasgow Coma Scale (GSC) score was 5.2 on admission and 6.9 at 48 hours. NETs were placed an average of 5.6 days after admission; an average of three abdominal films per patient were used to assess tube position. No patients had endoscopic NET placement during this period. Ten patients required fluoroscopic placement after failure to pass spontaneously by 5 days. Overall, transpyloric passage was achieved in 32 patients (43%), whereas 42 (57%) remained intragastric. There were no differences between the postpyloric and intragastric groups in days to full feeding (5 vs. 7 days), ventilator days (11.9 vs. 12.5), intensive care unit length of stay (15.5 vs. 15.1), or incidence of pneumonia (81 vs. 69%) or aspiration (6 vs 7%). Sixty-two patients (83%) were transferred to extended care facilities and 50 (68%) were still receiving NET feedings. Spontaneous transpyloric passage of NET occurred in less than one-half of patients with severe CHI. The routine use of adjunctive measures to promote transpyloric passage was not particularly successful, had no obvious benefit, and therefore may not be necessary.
据报道，早期肠内营养可改善重度闭合性颅脑损伤（CHI）患者的预后。然而，鼻肠管（NET）喂养的有效性和安全性受到质疑；误吸风险是主要关注点。我们的目的是确定经幽门迁移率、促进管道通过的辅助措施的有效性以及对肺部并发症的影响。74例中度至重度CHI患者接受肠内营养。入院时格拉斯哥昏迷量表（GSC）评分为5.2，48小时时为6.9。NET平均在入院后5.6天放置；每位患者平均使用三张腹部X光片评估管道位置。在此期间，没有患者接受内镜下NET放置。10例患者在5天内未能自行通过后需要透视下放置。总体而言，32例患者（43%）实现了经幽门通过，而42例（57%）仍留在胃内。幽门后组和胃内组在完全喂养天数（5天对7天）、呼吸机使用天数（11.9天对12.5天）、重症监护病房住院时间（15.5天对15.1天）、肺炎发生率（81%对69%）或误吸发生率（6%对7%）方面没有差异。62例患者（83%）被转至长期护理机构，50例（68%）仍在接受NET喂养。NET在重度CHI患者中自发经幽门通过的发生率不到一半。常规使用促进经幽门通过的辅助措施并不特别成功，没有明显益处，因此可能没有必要。
