Salasidis R, Fleiszer T, Johnston R
Department of Surgical and Trauma Critical Care, Montreal General Hospital, McGill University, PQ, Canada.
Crit Care Med. 1998 Jun;26(6):1036-9. doi: 10.1097/00003246-199806000-00023.
To test air insufflation as an adjunct to placement of enteral feeding tubes.
Prospective, randomized study.
Intensive care unit in a tertiary hospital.
Sixty-four consecutive patients requiring enteral nutrition, in whom a decision to insert a nasoenteral feeding tube was made.
A 12-Fr feeding tube was inserted to the level of the fundus of the stomach. A 60-mL syringe was used to pump 500 mL of air into the stomach. The tube was then advanced. An abdominal flat plate was obtained within 2 hrs of completion of the procedure and the tube position noted. If the tube was not in the duodenum, the patient was placed on a promotility agent and a repeat radiograph was performed the next day. The technique varied from our control technique only by the instillation of air.
Using the study technique, 21 of 32 tubes were successfully placed, as seen on the initial radiograph, in our study patients compared with only 12 of 34 tubes in our control patients (p< .02). In addition, the success rate at 24 hrs was 25 of 32 vs. 16 of 34 (p< .02). Only 3 of 21 tubes placed in the antrum, body, or fundus of the stomach advanced to the duodenum the following day, compared with 5 of 12 tubes initially placed in the pylorus (p< .075). No complications were noted.
Instilling air into the stomach may facilitate the ability to get the feeding tube to the level of the pylorus, at which point it is more likely to advance into the duodenum and beyond.
测试空气注入作为肠内喂养管放置辅助手段的效果。
前瞻性随机研究。
一家三级医院的重症监护病房。
64例连续需要肠内营养且决定插入鼻肠喂养管的患者。
将一根12F喂养管插入至胃底水平。使用一个60mL注射器向胃内注入500mL空气。然后推进该管。在操作完成后2小时内获取腹部平片并记录管的位置。如果管未进入十二指肠，患者使用促动力剂，次日重复进行X线检查。该技术与我们的对照技术的不同仅在于空气注入。
在我们的研究患者中，使用该研究技术，32根管中有21根在初次X线片上显示成功放置，而我们的对照患者中34根管只有12根成功放置（p<0.02）。此外，24小时时的成功率分别为32根中的25根和34根中的16根（p<0.02）。最初放置在胃窦、胃体或胃底的21根管中只有3根在次日推进至十二指肠，而最初放置在幽门的12根管中有5根推进至十二指肠（p<0.075）。未观察到并发症。
向胃内注入空气可能有助于使喂养管到达幽门水平，此时它更有可能推进至十二指肠及更远部位。
