针灸在重型颅脑损伤患者床边留置鼻肠管中的应用(1)
[摘要] 目的 探讨针灸对重型颅脑损伤患者床边鼻肠管置管成功率及置管中并发症的影响。 方法 选取2015年6月～2017年7月我院重症医学科及神经外科60例需行肠内营养支持的重型颅脑损伤患者，床边徒手置入螺旋型鼻肠管，摄片观察置管后24、48、72 h管端的位置。按照在置管过程中有否针灸分为对照组、针灸组。统计分析两组病例的置管成功率及并发症发生率。 结果 24、48、72 h对照组的置管成功率分别为6.7%(2/30)、40.0%(12/30)、80.0%(24/30)，针灸组分别为40.0%、86.7%、96.7%，两组差异有统计学意义(P<0.05)。对照组反流的发生率为36.7%(11/30)，针灸组为10.0%(3/30)，两组差异有统计学意义(P<0.05)。 结论 针灸可显著提高螺旋型鼻肠管的置管成功率，缩短置管时间，并能在一定程度上减少反流的发生。
[关键词] 针灸;重型颅脑损伤;鼻肠管;并发症
[中图分类号] R246 [文献标识码] B [文章编号] 1673-9701(2019)07-0102-04
[Abstract] Objective To investigate the effect of acupuncture and moxibustion on the success rate and complications of bedside nasointestinal catheterization in patients with severe craniocerebral injury. Methods 60 patients with severe craniocerebral injury who needed enteral nutrition support in the Department of Critical Care Medicine and Neurosurgery of our hospital from June 2015 to July 2017 were enrolled. The spiral nasointestinal tube was placed by hand at the bedside. The position of the tube end was observed through film at 24 hours， 48 hours and 72 hours after the catheter was placed. According to whether there was acupuncture and moxibustion in the process of catheterization， the patients were divided into the control group and the acupuncture group. The success rate of catheterization and the incidence of complications in the two groups were statistically analyzed. Results The success rate of catheterization in the control group was 6.7%(2/30)， 40.0%(12/30)， and 80.0%(24/30) at 24 hours， 48 hours， and 72 hours， respectively. And the success rate of catheterization in the acupuncture was 40.0%， 86.7% and 96.7%， and the difference between the two groups was statistically significant(P<0.05). The incidence of reflux in the control group was 36.7%(11/30)， and that in the acupuncture group was 10.0%(3/30). The difference between the two groups was statistically significant(P<0.05). Conclusion Acupuncture and moxibustion can significantly improve the success rate of catheterization of spiral nasointestinal tubes， shorten the time of catheterization， and reduce the occurrence of reflux to a certain extent.
[Key words] Acupuncture and moxibustion; Severe craniocerebral injury; Nasointestinal tube; Complications
重型顱脑损伤患者均存在不同程度上的意识障碍、自主进食功能障碍，另一方面受创伤、神经内分泌因素的影响出现糖耐受力降低、高分解代谢、负氮平衡等，故营养支持治疗已成为其综合治疗的重要方面[1]。在营养方式的选择上，按照“如果肠道有功能，使用它”的原则，提倡早期肠内营养。其中鼻肠管肠内营养支持因能减少误吸和反流概率，更适合意识障碍、吞咽困难的颅脑损伤患者[2]。目前常用的鼻肠管置管方法包括有创性的如手术中置鼻肠管、内镜引导下置鼻肠管，无创性的如徒手盲插置鼻肠管、被动等待法置鼻肠管等[3]。临床实践中，上述置管方法均各有优势，同时又各有不足。被动等待法置鼻肠管在本中心广为应用，其缺点是置管成功率偏低。针灸是祖国医学的瑰宝，已有大量国内外研究报道针灸可提高胃肠蠕动能力[4-6]。, 百拇医药(吴建华 黄思思 汪晓波 倪步烤 李俊纬 严玲微)
[关键词] 针灸;重型颅脑损伤;鼻肠管;并发症
[中图分类号] R246 [文献标识码] B [文章编号] 1673-9701(2019)07-0102-04
[Abstract] Objective To investigate the effect of acupuncture and moxibustion on the success rate and complications of bedside nasointestinal catheterization in patients with severe craniocerebral injury. Methods 60 patients with severe craniocerebral injury who needed enteral nutrition support in the Department of Critical Care Medicine and Neurosurgery of our hospital from June 2015 to July 2017 were enrolled. The spiral nasointestinal tube was placed by hand at the bedside. The position of the tube end was observed through film at 24 hours， 48 hours and 72 hours after the catheter was placed. According to whether there was acupuncture and moxibustion in the process of catheterization， the patients were divided into the control group and the acupuncture group. The success rate of catheterization and the incidence of complications in the two groups were statistically analyzed. Results The success rate of catheterization in the control group was 6.7%(2/30)， 40.0%(12/30)， and 80.0%(24/30) at 24 hours， 48 hours， and 72 hours， respectively. And the success rate of catheterization in the acupuncture was 40.0%， 86.7% and 96.7%， and the difference between the two groups was statistically significant(P<0.05). The incidence of reflux in the control group was 36.7%(11/30)， and that in the acupuncture group was 10.0%(3/30). The difference between the two groups was statistically significant(P<0.05). Conclusion Acupuncture and moxibustion can significantly improve the success rate of catheterization of spiral nasointestinal tubes， shorten the time of catheterization， and reduce the occurrence of reflux to a certain extent.
[Key words] Acupuncture and moxibustion; Severe craniocerebral injury; Nasointestinal tube; Complications
重型顱脑损伤患者均存在不同程度上的意识障碍、自主进食功能障碍，另一方面受创伤、神经内分泌因素的影响出现糖耐受力降低、高分解代谢、负氮平衡等，故营养支持治疗已成为其综合治疗的重要方面[1]。在营养方式的选择上，按照“如果肠道有功能，使用它”的原则，提倡早期肠内营养。其中鼻肠管肠内营养支持因能减少误吸和反流概率，更适合意识障碍、吞咽困难的颅脑损伤患者[2]。目前常用的鼻肠管置管方法包括有创性的如手术中置鼻肠管、内镜引导下置鼻肠管，无创性的如徒手盲插置鼻肠管、被动等待法置鼻肠管等[3]。临床实践中，上述置管方法均各有优势，同时又各有不足。被动等待法置鼻肠管在本中心广为应用，其缺点是置管成功率偏低。针灸是祖国医学的瑰宝，已有大量国内外研究报道针灸可提高胃肠蠕动能力[4-6]。, 百拇医药(吴建华 黄思思 汪晓波 倪步烤 李俊纬 严玲微)