重症患者螺旋型鼻肠管幽门后置管的影响因素(1)
【摘要】目的 分析重症患者螺旋型鼻肠管幽门后置管的影响因素。方法 回顾性分析2005年4月至2011年12月广东省人民医院综合ICU内放置螺旋型鼻肠管的重症患者。置管后24 h行床边X线评估，管端位于幽门后为置管成功。统计患者的一般资料、APACHE Ⅱ评分、治疗措施及药物使用等。按置管结局分为成功组和失败组。采用单因素分析和多元Logistic回归分析置管成功的影响因素。
结果 入选患者共508例，男性337例，女性171例，年龄(62.0±19.2)岁，APACHE Ⅱ评分为(21.9±7.3)分，205例置管成功，303例失败，置管成功率为40.4%。单因素分析表明APACHE Ⅱ评分≥20分、应用促胃动力药与镇静镇痛剂及儿茶酚胺类药物、存在人工气道和机械通气等，为影响置管成功的因素。多元Logistic回归分析表明APACHE Ⅱ评分≥20分、应用促胃动力药及镇静镇痛剂等，为影响幽门后置管的独立影响因素。结论 螺旋型鼻肠管总体置管成功率仍偏低，APACHE Ⅱ评分≥20分、应用镇静镇痛药和儿茶酚胺类药物、人工气道及机械通气的患者，置管成功率较低，使用促胃动力药可提高置管成功率，而年龄、性别对置管成功率无显著影响。
【关键词】重症患者；鼻肠管；幽门后置管；影响因素；促胃动力药；APACHE Ⅱ评分；单因素分析；多元Logistic回归分析
Factors facilitating the successful post-pyloric placement of spiral naso-jejunum tube in critically ill patients HU Bei， YE Heng， CHEN Chun-bo， GAO Xiang-min， ZENG Wen-xin， SUN Cheng， HUANG Wei-ping， LI Hui， ZHAN Wei-feng， ZENG Hong-ke. Department of Emergency and Critical Care Medicine， Guangdong General Hospital， Guangdong Academy of Medical Sciences， Guangzhou 510080， China
Corresponding author： CHEN Chun-bo， Email： e_5413@sohu.com；ZENG Hong-ke， Email： zenghongke@vip.163.com
【Abstract】Objective To analyze the potential factors facilitating post-pyloric placement of spiral naso-jejunum tube in critically ill patients. Methods A retrospective study was carried out in patients requiring enteral nutrition (EN) from Apr 2005 through Dec 2011 in Intensive Care Unit (ICU). Severity of illness was assessed with APACHE II score (acute physiology and chronic health evaluation II). A self-propelled spiral naso-jejunum tube was placed and observed for 24 hours. The forward movement and place of the tube tip was checked by bedside X-ray. The APACHE II score， therapeutic measures， agents administered within 24 hours after tube insertion were recorded. The patients were divided into the success group and the failure group identified by bedside X-ray whether the tube tip entered into jejunum or not. Univariate analysis and multivariate Logistic regression analysis were used to find out the potential factors impacting on the success or failure in post-pyloric placement of naso-jejunum tube. Results A total of 508 patients composed of 337 male and 171 female， and aged (62.0±19.2 )years with APACHE Ⅱ score of (21.9±7.3) were enrolled for study. The placement was successful in 205 (40.4%) of 508 patients. Univariate analysis showed that APACHE Ⅱ score≥20， sedatives and analgesics， catecholamines， prokinetics， artificial airway and mechanical ventilation were potential factors facilitating the post-pyloric placement of naso-jejunum tube. Multivariate logistic regression identified that APACHE Ⅱ score≥20， sedatives and analgesics and prokinetics were independent factors facilitating the post-pyloric placement of naso-jejunum tube. Conclusions The success rate of self-propelled spiral nasojejunal tubes insertion was relatively low. The prokinetics contributed higher success rate of naso-jejunum tube placement than factors of APACHE Ⅱ score≥20， sedative and analgesic， catecholamine drugs， artificial airway and mechanical ventilation. There were no effects of age and gender on the placement of naso-jejunum tube.
, 百拇医药(胡北 叶珩 陈纯波 高向民 曾文新 孙诚 黄伟平 李辉 詹伟锋 曾红科)
结果 入选患者共508例，男性337例，女性171例，年龄(62.0±19.2)岁，APACHE Ⅱ评分为(21.9±7.3)分，205例置管成功，303例失败，置管成功率为40.4%。单因素分析表明APACHE Ⅱ评分≥20分、应用促胃动力药与镇静镇痛剂及儿茶酚胺类药物、存在人工气道和机械通气等，为影响置管成功的因素。多元Logistic回归分析表明APACHE Ⅱ评分≥20分、应用促胃动力药及镇静镇痛剂等，为影响幽门后置管的独立影响因素。结论 螺旋型鼻肠管总体置管成功率仍偏低，APACHE Ⅱ评分≥20分、应用镇静镇痛药和儿茶酚胺类药物、人工气道及机械通气的患者，置管成功率较低，使用促胃动力药可提高置管成功率，而年龄、性别对置管成功率无显著影响。
【关键词】重症患者；鼻肠管；幽门后置管；影响因素；促胃动力药；APACHE Ⅱ评分；单因素分析；多元Logistic回归分析
Factors facilitating the successful post-pyloric placement of spiral naso-jejunum tube in critically ill patients HU Bei， YE Heng， CHEN Chun-bo， GAO Xiang-min， ZENG Wen-xin， SUN Cheng， HUANG Wei-ping， LI Hui， ZHAN Wei-feng， ZENG Hong-ke. Department of Emergency and Critical Care Medicine， Guangdong General Hospital， Guangdong Academy of Medical Sciences， Guangzhou 510080， China
Corresponding author： CHEN Chun-bo， Email： e_5413@sohu.com；ZENG Hong-ke， Email： zenghongke@vip.163.com
【Abstract】Objective To analyze the potential factors facilitating post-pyloric placement of spiral naso-jejunum tube in critically ill patients. Methods A retrospective study was carried out in patients requiring enteral nutrition (EN) from Apr 2005 through Dec 2011 in Intensive Care Unit (ICU). Severity of illness was assessed with APACHE II score (acute physiology and chronic health evaluation II). A self-propelled spiral naso-jejunum tube was placed and observed for 24 hours. The forward movement and place of the tube tip was checked by bedside X-ray. The APACHE II score， therapeutic measures， agents administered within 24 hours after tube insertion were recorded. The patients were divided into the success group and the failure group identified by bedside X-ray whether the tube tip entered into jejunum or not. Univariate analysis and multivariate Logistic regression analysis were used to find out the potential factors impacting on the success or failure in post-pyloric placement of naso-jejunum tube. Results A total of 508 patients composed of 337 male and 171 female， and aged (62.0±19.2 )years with APACHE Ⅱ score of (21.9±7.3) were enrolled for study. The placement was successful in 205 (40.4%) of 508 patients. Univariate analysis showed that APACHE Ⅱ score≥20， sedatives and analgesics， catecholamines， prokinetics， artificial airway and mechanical ventilation were potential factors facilitating the post-pyloric placement of naso-jejunum tube. Multivariate logistic regression identified that APACHE Ⅱ score≥20， sedatives and analgesics and prokinetics were independent factors facilitating the post-pyloric placement of naso-jejunum tube. Conclusions The success rate of self-propelled spiral nasojejunal tubes insertion was relatively low. The prokinetics contributed higher success rate of naso-jejunum tube placement than factors of APACHE Ⅱ score≥20， sedative and analgesic， catecholamine drugs， artificial airway and mechanical ventilation. There were no effects of age and gender on the placement of naso-jejunum tube.
, 百拇医药(胡北 叶珩 陈纯波 高向民 曾文新 孙诚 黄伟平 李辉 詹伟锋 曾红科)