Patrick P G, Marulendra S, Kirby D F, DeLegge M H
Section of Nutrition, Virginia Commonwealth University, Medical College of Virginia Hospitals, Richmond, USA.
Gastrointest Endosc. 1997 Jan;45(1):72-6. doi: 10.1016/s0016-5107(97)70305-5.
Historically, placement of small bowel nasoenteric feeding tubes in the critically ill patient has been difficult because of lack of bedside fluoroscopy, inadequately designed endoscopic tubes, or failure of the tube to spontaneously pass into the duodenum following placement.
We followed-up 54 consecutive critically ill patients who had a combined nasogastric-jejunal feeding tube placed at the bedside using a new endoscopic, nonfluoroscopic method of placement. Data were obtained on the placement procedure, outcomes, and complications that followed.
Tubes were successfully placed in 94% of the patients in an average time of 12 minutes. Negative outcomes included the following: inadvertent removal by patient or staff (21%), intolerance to tube feeding (14%), clogging (9%), kinking (6%), and cracking at the tube adapter (11%). The duration of the tube following placement ranged from 1 to 42 days, with an average of 9 days.
The combined tubes were easy to place endoscopically. The endoscopic, nonfluoroscopic method of placing feeding tubes can be performed at the bedside and allows for gastric decompression and enteral feeding to be rapidly and efficiently achieved, which is particularly useful for intubated patients in an intensive care setting. Negative outcomes should decrease by avoidance of inadvertent tube removal and by improved tube maintenance and materials.
历史上，由于缺乏床边荧光镜检查、内镜管设计不当或放置后管子未能自行进入十二指肠，在重症患者中放置小肠鼻肠饲管一直很困难。
我们对54例连续的重症患者进行了随访，这些患者采用一种新的内镜非荧光镜放置方法在床边放置了鼻胃 - 空肠联合饲管。收集了关于放置过程、结果及随后并发症的数据。
94%的患者饲管成功放置，平均用时12分钟。不良结果包括：患者或工作人员意外拔除（21%）、不耐受管饲（14%）、堵塞（9%）、扭结（6%）以及管接头处破裂（11%）。放置后饲管使用时长为1至42天，平均9天。
联合饲管通过内镜易于放置。内镜非荧光镜放置饲管的方法可在床边进行，能快速有效地实现胃减压和肠内喂养，这对重症监护病房中的插管患者尤为有用。通过避免意外拔管以及改进饲管维护和材料，不良结果应会减少。
