床旁电磁导航下留置鼻肠管在特重度烧伤患者中的应用效果

张玲玲; 张伟; 王聪聪; 张丽萍

doi:10.3760/cma.j.cn501225-20231010-00108

床旁电磁导航下留置鼻肠管在特重度烧伤患者中的应用效果

doi: 10.3760/cma.j.cn501225-20231010-00108

山东第一医科大学附属省立医院烧伤与创面修复外科，济南　　250021

基金项目:

山东省中医药科技项目面上项目 M-2023037

山东省自然科学基金培养基金 ZR2019PH035

详细信息

通讯作者:
张伟，Email：zhangwei4124@163.com

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出版历程
- 收稿日期: 2023-10-10

Application effects of indwelling nasoenteric tubes under bedside electromagnetic navigation in patients with extremely severe burns

Department of Burn and Wound Repair, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China

Funds:

General Program of Shandong Traditional Chinese Medicine Science and Technology Project M-2023037

Shandong Provincial Natural Science Foundation Cultivation Fund ZR2019PH035

More Information

Corresponding author: Zhang Wei, Email: zhangwei4124@163.com

摘要

摘要: 目的探讨床旁电磁导航下留置鼻肠管在特重度烧伤患者中的应用效果。方法该研究为回顾性队列研究。将2017年4月—2021年12月山东第一医科大学附属省立医院（以下简称本院）收治的入院24 h内采用盲插法留置鼻肠管的27例特重度烧伤患者纳入盲插法组，其中男17例、女10例，年龄（52±16）岁；将2022年1月—2023年10月本院收治的入院24 h内采用床旁电磁导航下留置鼻肠管的33例特重度烧伤患者纳入电磁导航组，其中男24例、女9例，年龄（50±15）岁。统计一次留置鼻肠管成功率和留置鼻肠管耗时；留置鼻肠管后0.5 h内，采用利克特5级量表评估患者对留置鼻肠管的满意度，并计算满意率；采用数字评价量表评估留置鼻肠管前与留置鼻肠管后即刻留置鼻肠管操作者（以下简称操作者）腰背痛程度，并计算留置鼻肠管后即刻操作者腰背痛发生率。结果电磁导航组患者的一次留置鼻肠管成功率为96.97%（32/33），明显高于盲插法组的74.07%（20/27），P<0.05；留置鼻肠管耗时为10（8，13）min，明显短于盲插法组的30（22，40）min（Z=-6.17，P<0.05）。留置鼻肠管后0.5 h内，电磁导航组患者对留置鼻肠管的满意率为96.97%（32/33），明显高于盲插法组的70.37%（19/27），P<0.05。留置鼻肠管前，2组患者的操作者的腰背部疼痛评分均为0分。留置鼻肠管后即刻，电磁导航组患者的操作者的腰背痛发生率为45.45%（15/33），明显低于盲插法组的85.19%（23/27），P<0.05。结论床旁电磁导航下留置鼻肠管成功率高、耗时短，患者对留置鼻肠管的满意度高，同时可大大降低操作者职业腰背痛发生率，有利于特重度烧伤患者尽早启动肠内营养。
- 烧伤 /
- 营养支持 /
- 肠道营养 /
- 鼻肠管 /
- 电磁导航
Abstract: Objective To investigate the application effects of indwelling nasoenteric tubes under bedside electromagnetic navigation in patients with extremely severe burns. Methods This study was a retrospective cohort study. The 27 patients with extremely severe burns who were admitted to Shandong Provincial Hospital Affiliated to Shandong First Medical University (hereinafter referred to as the hospital) from April 2017 to December 2021 and inserted nasoenteric tubes by blind insertion within 24 h of admission were included in blind insertion group, including 17 males and 10 females, aged (52±16) years. The 33 patients with extremely severe burns who were admitted to the hospital from January 2022 to October 2023 with indwelling nasoenteric tubes under bedside electromagnetic navigation within 24 h of admission were included in electromagnetic navigation group, including 24 males and 9 females, aged (50±15) years. The one-time success rate of indwelling nasoenteric tube and the time of indwelling nasoenteric tube were recorded. Within 0.5 h after indwelling nasoenteric tube, the satisfaction of patients with indwelling nasoenteric tube was assessed using 5-grade Likert scale, and the satisfaction rate was calculated. Numerical rating scale was used to assess the degree of low back pain in the operators of indwelling nasoenteric tube (hereinafter referred to as operators) before and immediately after indwelling nasoenteric tubes, and the incidence rate of low back pain in operators immediately after indwelling nasoenteric tubes was calculated. Results The one-time success rate of indwelling nasoenteric tube of patients in electromagnetic navigation group was 96.97% (32/33), which was significantly higher than 74.07% (20/27) in blind insertion group (P<0.05). The time of indwelling nasoenteric tube of patients in electromagnetic navigation group was 10 (8, 13) min, which was significantly shorter than 30 (22, 40) min in blind insertion group (Z=-6.17, P<0.05). Within 0.5 h after indwelling nasoenteric tube, the satisfaction rate of patients with indwelling nasoenteric tube in electromagnetic navigation group was 96.97% (32/33), which was significantly higher than 70.37% (19/27) in blind insertion group (P<0.05). Before indwelling the nasoenteric tubes, the low back pain scores of operators of patients in the 2 groups were both 0. Immediately after indwelling nasoenteric tubes, the incidence rate of low back pain in operators of patients in electromagnetic navigation group was 45.45% (15/33), which was significantly lower than 85.19% (23/27) in blind insertion group (P<0.05). Conclusions Indwelling nasoenteric tube under bedside electromagnetic navigation has high success rate, short time, and high satisfaction with indwelling nasoenteric tube in patients. Meanwhile, it can greatly reduce the incidence of the operators' occupational low back pain, and it is beneficial to start enteral nutrition as early as possible for patients with extremely severe burns.
- Burns /
- Nutritional support /
- Enteral nutrition /
- Nasoenteric tube /
- Electromagnetic navigation
张玲玲：酝酿和设计研究、采集资料、分析数据、撰写和修改论文；张伟：酝酿和设计研究、采集资料、分析数据、修改论文、经费支持；王聪聪：采集资料、分析数据、修改论文；张丽萍：采集资料、分析数据、统计分析

所有作者均声明不存在利益冲突

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参考文献(36)

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下载: 全尺寸图片幻灯片

1 特重度烧伤患者床旁电磁导航下留置鼻肠管成功后三维显像图和腹部X线片。1A、1B.分别为三维显像前位像视图、侧面图视图，可见鼻肠管出现2处“C形轨迹”，第1个“C形轨迹”提示鼻肠管通过胃贲门进入胃内，第2个“C形轨迹”提示鼻肠管通过幽门进入小肠；1C.三维显像深度横剖面视图，饲管顶端位置出现下降轨迹提示鼻肠管进入小肠；1D.留置鼻肠管后0.5 h内床旁拍摄的腹部X线片显示，鼻肠管通过幽门进入小肠内

注：图1B、1C中的B代表脊柱

下载: 全尺寸图片幻灯片

表1 2组特重度烧伤患者临床资料比较

表1. Comparison of clinical data between two groups of patients with extremely severe burns

组别	例数	性别（例）		年龄（岁，x¯±s）	烧伤总面积（例）		行气管切开（例）		行机械通气（例）
组别	例数	男	女	年龄（岁，x¯±s）	70%~90%TBSA	>90%TBSA	是	否	是	否
盲插法组	27	17	10	52±16	14	13	20	7	13	14
电磁导航组	33	24	9	50±15	20	13	28	5	18	15
统计量值		χ²=0.65		t=0.36	χ²=0.46		χ²=1.08		χ²=0.24
P值		0.419		0.720	0.496		0.299		0.622
注：对盲插法组患者采用盲插法置入鼻肠管，对电磁导航组患者采用电磁导航技术经饲管定位系统置入鼻肠管；TBSA为体表总面积