ABSTRACT
Objective To investigate the value of endoscopic assisted nasal jejunal tube placement and jejunum nutrition in treatment of critically illed patients. Methods This study was a prospective study. 56 patients with severe cerebrovascular diseases in the department of NICU from May 2014 to May 2017 were enrolled in this study. All of the patients were found to have an increased gastric remnant within 72 hours after admission (>100 ml). In the nasal jejunal group, 28 patients received nasal endoscopy and nasal endoscopic feeding, and 28 cases were treated with routine nasogastric tube and enteral nutrition. Comparing the two groups of patients with gastrointestinal complications (including vomiting, gastroesophageal reflux, abdominal distension, diarrhea, stress ulcer incidence) and nutritional status parameters (including serum albumin, prealbumin, hemoglobin), incidence of hospital acquired pneumonia and inflammation indexes (including WBC, PCT and CRP), stay at NICU time, NICU expenses, GCS score and mortality rate. Results The success rate of nasal intestinal tube placement under nasal endoscopy guided wire was 100.0%. The nasal jejunal nutrition status parameters were better, NICU check-in time was shorter, NICU expenses were lower, and the inflammation index was lower than the control group. There were no significant differences in the incidence of gastrointestinal complications, the incidence of hospital acquired pneumonia, the GCS score and the fatality rate between the two groups. Conclusion For the patients with severe gastric remnant increase in NICU, it is worth recommending that naso jejunal tube be inserted into the jejunum by endoscopy and using jejunum nutrition.
ABSTRACT
Objective To compare the safety and efficacy of different methods for nasal jejunum tube placement in patients with mechanical ventilation.Methods From March 1,2015 to August 31,2017,patients with mechanical ventilation needed nasal jejunum tube placement were randomly divided into three groups,and three groups were provided with supine position(Group A),head forward flexion (Group B) and head back position(Group C),and nasal jejunum tubes were inserted by the same person.Time of reaching stomach,time of stomach to jejunum,and number of successful cases were recorded.Results In Group C,time of reaching stomach was significantly shorter than that in Group A and Group B(P＜0.01),time of stomach to jejunum in Group B was significantly shorter than that in Group A and Group C(P＜0.01).There were no statistically significant differences among three groups in number of successful cases in stomach and in jejunum(P＞O.05).Conclusion The method of head elevation and head back position is easy for nasal jejunum tube to pass through the throat with spiral movement;right lateral position together with uniform continuous advancing of nasal jejunum tube can have higher successful rate,which is conducive to the establishment of early enteral nutrition in patients with mechanical ventilation.
ABSTRACT
Objective To discuss the appropriate timing of providing enteral nutrition through nasojejunal tube for patients with severe craniocerebral injury.Methods 126 cases of patients were divided into 3 groups randomly,providing enteral nutrition through naso-jejunal tube for the first group,the second group and the third group within 12～24 hours,48 hours later and 72 hours later after injury respectively.The nutrition situation of 3 groups was recorded 6 hours later,48 hours later,on the 5th day and the 10th day,including indicators such as total serum protein,blood albumin,serum creatinine,etc and complication cases of diarrhea,hemorrhage of digestive tract,palirrhea,aspiration,inhalation pneumonia and so on within 2 weeks after injury.Results In terms of indicators of albumin,creatinine 48 hours after injury and total protein,albumin and creatinine on the 5th day and 10th day,the first group were better than the second and third group,there were statistic differences between the three groups.Complication comparison within 2 weeks after injury:the difference of palirrhea cases among the three groups was significant,the third group had a higher ratio than the first and second group.And there was no statistic difference in the other indicators like diarrhea,hemorrhage of digestive tract,aspiration and inhalation pneumonia.Conclusions It is high time that patients with simple severe craniocerebral injury are provided with enteral nutrition through naso-jejunal tube within 12 to 24 hours,which can improve patients nutrition situation without the increase of the complications.