Reed R L, Eachempati S R, Russell M K, Fahkry C
Department of Surgery, Cornell University Medical Center, New York, NY, USA.
J Trauma. 1998 Aug;45(2):388-93. doi: 10.1097/00005373-199808000-00034.
Enteral nutrition is less expensive and often preferred to parenteral nutrition in the critically ill or injured patient. Gastric feedings are poorly tolerated in some patients, however, and postpyloric access is frequently difficult to obtain. In this report, we describe our experience with a new technique for bedside endoscopic placement of small intestinal feeding tubes.
Using both prospective and retrospective analysis, we studied our results with endoscopically placed postpyloric feeding tubes in intensive care unit (ICU) patients. In this method, a 7F nasobiliary tube is passed via an endoscope into the proximal small bowel by a "push" technique. We recorded the demographic data of the patients, the feeding regimens subsequently used for these patients, and the overall feasibility and complications of the procedures themselves.
The technique was performed on 71 occasions in 61 ICU patients. The entire procedure averaged 29 minutes in a prospectively evaluated subset of patients. Small intestinal cannulation was successful in every case, including cases in which fluoroscopic attempts had failed. No complications developed from placement of the feeding tubes.
This report demonstrates that our bedside method of endoscopic placement of proximal small-bowel feeding tubes may be safely and expediently performed in ICU patients. Although not yet formally compared with other techniques, this procedure may have some advantages over traditional methods of small-bowel feeding tube placement.
肠内营养费用较低，在重症或受伤患者中通常比肠外营养更受青睐。然而，一些患者对胃内喂养耐受性差，且经常难以实现幽门后通路。在本报告中，我们描述了一种床边内镜下放置小肠喂养管的新技术的经验。
我们采用前瞻性和回顾性分析，研究了重症监护病房（ICU）患者内镜下放置幽门后喂养管的结果。在该方法中，通过“推送”技术将一根7F鼻胆管经内镜送入近端小肠。我们记录了患者的人口统计学数据、随后用于这些患者的喂养方案以及操作本身的总体可行性和并发症。
该技术在61例ICU患者中进行了71次。在前瞻性评估的患者亚组中，整个操作平均耗时29分钟。小肠插管在每例患者中均成功，包括透视尝试失败的病例。喂养管放置未出现并发症。
本报告表明，我们在床边内镜下放置近端小肠喂养管的方法可在ICU患者中安全、便捷地进行。尽管尚未与其他技术进行正式比较，但该操作可能比传统的小肠喂养管放置方法具有一些优势。
