Different enteral nutrition methods combined with swallowing rehabilitation training for Alzheimer's disease complicated by dysphagia / 中国基层医药

Objective:To investigate the clinical efficacy of different enteral nutrition methods combined with swallowing rehabilitation training in the treatment of Alzheimer's disease complicated by dysphagia.Methods:A total of 120 patients with Alzheimer's disease and dysphagia who received treatment in the Department of Geriatric Medicine, the Second Hospital of Jinhua from October 2019 to March 2021 were included in this study. They were randomly and evenly divided into four groups: A, B, C, and D. Patients in groups A, B, C, and D were given nasogastric tube feeding, naso-intestinal tube feeding, nasogastric tube feeding + swallowing rehabilitation training, and naso-intestinal tube feeding + swallowing rehabilitation training, respectively. After 12 weeks of treatment, total response rate, nutritional status, and complications were compared between the four groups.Results:After 12 weeks of treatment, total response rate in group D was the highest (100.0%), which was significantly higher than that in the other three groups (group A: 13.3%; group B: 40.0%; group C: 73.3%; χ2 = 45.88, 25.71, 9.23, all P < 0.05). After treatment, the nutritional status [body mass index (BMI): (21.42 ± 1.85) kg/m 2, (23.17 ± 2.03) kg/m 2] and patient satisfaction (60.0%, 100.0%) in groups C and D were significantly superior to those in group A [BMI: (19.01 ± 1.72) kg/m 2; patient satisfaction: 10.0%) and group B [BMI: (19.86 ± 1.69) kg/m 2; patient satisfaction: 33.3%]. Group D had the best nutritional status ( t = 7.01, 5.14, 1.78, all P < 0.05) and the highest patient satisfaction ( χ2 = 49.09, 30.00, 15.00, all P < 0.001). Conclusion:Naso-intestinal tube feeding combined with swallowing rehabilitation training is the best treatment for Alzheimer's disease complicated by dysphagia among the studied enteral nutrition feeding methods and therefore deserves clinical promotion.

Progress on enteral nutrition therapy for acute pancreatitis / 中华临床营养杂志

Acute pancreatitis (AP) is an acute inflammatory disease of various severity, characterized by upper abdominal pain, elevated pancreatic enzymes, and changes in imaging features of the pancreas. According to the degree of pancreatic injury and the presence and duration of systemic organ failure, AP is classified into mild, moderate, or severe disease. Most AP patients experience mild disease and recover quickly, while up to 20% progress to moderate or severe disease, with an estimated risk of death as high as 30%. Severe acute pancreatitis (SAP) is a clinical emergency with a critical condition and poor prognosis, especially in patients with pancreatic and/or peripancreatic tissue infection and necrosis. AP is essentially an inflammatory process that can lead to protein catabolism and increased metabolic rates, further resulting in negative nitrogen balance. The goal of nutritional support therapy for AP is to correct negative nitrogen balance, reduce inflammation, and improve prognosis. Enteral nutrition therapy is an important component of clinical treatment of SAP. This review aims to summarize the nutritional support treatment in AP based on the existing clinical data and experience.

Nasogastric tube insertion using conventional versus bubble technique for its confirmation in anesthetized patients: a prospective randomized study

Abstract Background: Nasogastric tube insertion and confirmation of its position can be difficult in the anesthetized patient. The purpose of the present study was to compare the bubble technique with the conventional method for confirmation of nasogastric tube placement in these patients. Methods: Two hundred sixty adult patients, aged between 20-70 years, posted for surgeries requiring general anesthesia, tracheal intubation, and a nasogastric tube were enrolled in this study. Patients were randomized into 2 groups: Group B (Bubble group) and Group C (Control group). In Group C, a conventional technique using a lubricated nasogastric tube was positioned through the nostril with head remained neutral. In Group B, 2% lidocaine jelly was added to the proximal end to form a single bubble. The correct placement of the nasogastric tube in the stomach was confirmed by fluoroscopy by an independent observer intraoperatively. Results: The duration of nasogastric tube insertion was 57.2 ± 13.3seconds in Group B and 59.8 ± 11.9seconds in Group C (p = 0.111). The confirmation rate of the bubble technique was 76.8% (95% CI: 68.7-83.3), which was significantly better than the conventional method where the confirmation rate was 59.7% (95% CI 50.9-67.9), p< 0.001. When compared to fluoroscopy, bubble technique was found to have a sensitivity of 92.3% (95% CI: 85.6-96.1) with specificity of 81.0% (95% CI: 60.0-92.3), positive predictive value of 96.0% (95% CI: 90.2-98.4), and a moderate negative predictive value of 68.0% (95% CI: 48.4-82.8). Conclusions: The bubble technique of nasogastric tube insertion has a higher confirmation rate in comparison to the conventional technique. Trial Registry Number: Clinical Trial Registry of India (CTRI/2018/09/015864).

Decompression effects of nasointestinal tube versus nasogastric tube for adhesive intestinal obstruction: a Meta-analysis / 中华消化外科杂志

Adhesive intestinal obstruction is the most common type of ileus, and conserva-tive treatment serves as its preferred treatment option. In the course of conservative treatment, gastrointestinal decompression will relieve symptoms, prevent ileus progression and promote gas-trointestinal function recovery, which has significant clinical effects. Currently, decompression effects of nasointestinal tubes and nasogastric tubes are controversial. There is a previous Meta-analysis evaluating decompression effects of these two methods, but this analysis includes non-randomized controlled trial and lacks research about Chinese patients. Therefore, the authors con-duct a Meta-analysis to evaluate decompression effects of nasointestinal tubes versus nasogastric tubes for adhesive intestinal obstruction.

Role of Jabalpur Score in Predicting Mortality Among Patients with Peritonitis Secondary to Peptic Ulcer Perforation

Background: Commonest surgical emergency cases in developing countries isPerforativeperitonitis. These sequence of events leads to increasedmorbidity and mortality. The events can be modified to decrease mortality through early interventions like specific therapeutic procedures, these determine the outcome.. Decreasing mortality also depends on recognition of theseriousness of disease, an accurate assessment andclassification of patient’s risks,to overcome these problems, Jabalpur peritonitis index was made. Aim: To evaluate the role of Jabalpur scoringsystem among patients of peritonitis secondary to rupture of peptic ulcer in predicting mortality. Method: Prospective observational study was conducted on patients of peritonitis secondary to rupture of peptic ulcer.The study was conducted on all the patients attending the surgery out patient department and emergency department in K R Hospital under MMC &RI , Mysore, Karnataka, India, from period of January 2018 – August2019. Conclusion: There is association between all the factors used in the Jabalpur scoring and mortality and as the score increased there is increase in mortality . The score has high sensitivity and specificity in predicting mortality.

Evidence summary of the method for measuring the length of nasogastric tube insertion / 中国实用护理杂志

Objective:To systematically retrieve, evaluate and summarize the research evidence on the measurement method of adult nasogastric tube indwelling length and provide a basis for clinical nursing practice.Methods:To search for Cochrane Library(CD-SR, DARE), Joanna Briggs(JBI), PubMed (MEDLINE), Web of Science electronic database, China Biomedical Literature Database (CBM), Wanfang Database, China Knowledge Network from the establishment of the database to December 2018. Two researchers independently evaluated the quality of the literature and extracted the data.Results:A total of 9 articles were included in the study. The recommended anatomical landmarks for measuring the length of the inserted gastric tube included XNE, NEX, XJN, Hanson method, GWNUF model, earlobe to xiphoid to navel-nose tip to earlobe NEX 10 cm. The tip of the nasogastric tube and all its lateral hole locations obtained by the Hanson method, the GWNUF model, and the XEN 10 cm method were more likely to be located in the stomach.Conclusion:Although NEX is an external measurement method that is widely used in clinical practice, it has proven to be insufficiently accurate and has considerable risks. Therefore, the method of measuring the length of the nasogastric tube insertion should be carefully selected for teaching or use in practice.

Effects of preemptive nasogastric tube placement on improving nutrition and feeding status of infants with congenital heart disease / 中国实用护理杂志

Objective:To evaluate the effectiveness and safety of preemptive nasogastric tube placement for improving nutritional status and clinical outcomes in hospitalized infants with congenital heart disease.Methods:Children from 0 to 12 months with congenital heart disease hospitalized in cardiovascular center of Children's Hospital of Fudan University from February to July 2018 were selected as control group through continuous sampling. Children hospitalized were selected from September 2018 to February 2019 as intervention group. The control group followed the current feeding method, the intervention group used preemptive nasogastric tube placement. The nutritional indicators, feeding indicators and clinical outcomes of the two groups were compared to evaluate the intervention effect.Results:The serum albumin and prealbumin of the children in the intervention group were (36.81±4.59) g/L and (162.74±48.17) g/L, which were higher than those in the control group (34.80±5.21) g/L and (142.98± 33.96) g/L, the difference between the two groups was statistically significant ( t values were -2.721, -3.169, both P<0.05); the daily enteral intake, calorie intake and single enteral calorie intake of children in the intervention group were (124.93±27.97) ml·kg -1·d -1, (376.48±88.53) kj·kg -1·d -1, (48.39±9.13) kj·kg -1·time -1, higher than the control group (114.74±30.63) ml·kg -1·d -1, (330.01±90.75) kj·kg -1·d -1, (44.24±13.31) kj·kg -1·time -1, the difference between the two groups was statistically significant ( t values were -2.511, -3.750, -2.382, all P<0.05). the incidence of feeding difficulties in the intervention group was 4.95% (5/101) lower than 14.68% (16/109) of the control group, the difference between the two groups was statistically significant ( χ2 value was 5.513, P<0.05); the proportion of children in the intervention group reaching the target feeding amount when discharged from the hospital was 97.03% (98/101), higher than 84.40% (92/109) of the control group, the difference between the two groups was statistically significant ( χ2 value was 9.699, P<0.05). Conclusions:Preemptive nasogastric tube placement is safety and effectively for patients with congenital heart disease in clinical infants. but it still needs a large sample for a long time to confirm its effectiveness.

Nutrición en pancreatitis aguda: nuevos conceptos para un viejo problema / Nutrition in acute pancreatitis: new concepts for an old problem

Resumen El manejo de la nutrición en pancreatitis aguda ha sido cuestión de debate. Durante muchos años el concepto de reposo pancreático fue generalizado y aceptado en el manejo de la pancreatitis aguda. Actualmente se conoce que la nutrición temprana permite mantener la integridad de la barrera intestinal, que previene la aparición de complicaciones infeccionas y se asocia con una menor estancia hospitalaria, menos complicaciones y un mejor pronóstico. En esta revisión se discuten las principales ventajas de la nutrición temprana en pancreatitis aguda, la seguridad de la misma y la vía de administración.

Abstract Nutrition management in acute pancreatitis has been a matter of debate worldwide. For many years, the concept of pancreatic rest was widespread and accepted to treat acute pancreatitis. However, current knowledge of early nutrition allows maintaining the intestinal barrier's integrity, preventing the occurrence of infectious complications, which is associated with a shorter hospital stay, fewer complications, and better prognosis. This review presents the main advantages of early nutrition in acute pancreatitis, its safety, and the route of administration.

Efficacy of enteral nutrition through percutaneous endoscopic gastrostomy/jejunostomy in patients with severe cerebral hemorrhage / 中华神经医学杂志

Objective:To investigate the therapeutic efficacy of enteral nutrition through percutaneous endoscopic gastrostomy/jejunostomy (PEG/PEJ) in patients with severe cerebral hemorrhage.Methods:Eighty-five patients with severe cerebral hemorrhage admitted to our hospital from January 2015 to December 2018 were enrolled into this retrospective study. According to ways of enteral nutrition, all 85 patients were divided into nasogastric tube group ( n=44) and PEG/PEJ tube group ( n=41). The clinical data were analyzed retrospectively, and the enteral nutrition treatment efficacy, incidence of complications, and length of hospital stays between the two groups were compared. Results:The incidences of diarrhea (14.6%, 6/41), gastric retention (34.1%, 14/41), and hypoproteinemia (26.8%, 11/41) in PEG/PEJ tube group were significantly lower than those in nasogastric tube group (38.6% [17/44], 59.1% [26/44], and 47.7% [21/44], P<0.05). However, the rate of obstruction ducts in PEG/PEJ tube group (34.1%, 14/41) was significantly higher than that in nasogastric tube group (11.4%, 5/44, P<0.05). As compared with the patients in nasogastric tube group, patients in the PEG/PEJ tube group had significantly shorter average length of hospital stays ([35.2±4.7] d vs. [37.6±5.4] d, P<0.05). The NRS2002 scores of patients in the nasogastric tube group and PEG/PEJ tube group after enteral nutrition treatment were 1.73±0.52 and 1.87±0.64, respectively, without significant difference ( P<0.05). Conclusion:The enteral nutrition treatment through PEG/PEJ could significantly reduce the incidences of diarrhea, gastric retention and hypoproteinemia, and shorten the average length of hospital stays in patients with severe cerebral hemorrhage; rate of obstruction of percutaneous endoscopic jejunostomy ducts should be reduced.

In vitro comparison test for chemical solid oral generic drugs administered by nasogastric tubes / 国际药学研究杂志

At present, the dosage and administration items in the marketing instructions of some oral solid brand drugs approved in China include related contents for administration via nasogastric tube. In order to achieve consistency with the original drugs in quality and efficacy, the generic drugs investigators should confirm whether the generic drugs and the original drugs have the same in vitro characteristics under the conditions of administration by nasogastric tube. The purpose is to eliminate the clinical risks brought by the way of administration. This article summarizes the experimental design and evaluation points for the in vitro comparative study of the solid oral generic drugs which can be administered by nasogastric tube, while referring to the individual drug guidelines issued by FDA and the related literature published, so as to provide a reference for the technical system construction for the consistency evaluation of oral solid dosage forms.

A Comparative Study between Single versus Double Layered Bowel Anastomosis in a Tertiary Care Hospital

Background: Intestinal anastomosis is a frequently performedprocedure equally in elective and emergency cases andtherefore, it is authoritative for surgeons and residents to beacquainted with the art of bowel anastomosis. The technique ofanastomosis is dependent upon the site, situation of the boweland the fundamental disease etiology, and the generalcomplaint of the subject. As per a recent Cochrane reviewcomparing the effectiveness of single layer and double layergastrointestinal anastomosisMaterials and Methods: The present prospective, randomizedcomparative study was conducted in the general surgicaldepartment of the Hospital for a period of 2 years. Subjectsrequiring intestinal resection were evaluated for eligibility to theward. All subjects received same antibiotics postoperativelylike Injection Ceftriaxone and Metronidazole including astandard postoperative care. Subjects were followed up for twoweeks after surgery. Any instant or late complications werenoted. All the data thus obtained was arranged in a tabulatedform and analyzed using SPSS software. Probability value ofless than 0.05 was considered as significant.Results: There were total 100 subjects included in the study,out of which 50 were managed by Single layered and 50 byDouble layered technique. The mean age of the subjects was37.53+/-4.22years. The mean duration of nasogastric tube insitu was 1.92±0.80 and 2.35 ± 1.03 days respectively in singleand double layer technique. The return of bowel soundpostoperatively was 2.45±1.13 days in single layer and 3.2 ±1.36 days in double layer technique. There was a significantdifference in both the groups. There was 1 case of anastomoticleak with double layered technique. Abdominal abscess wasseen in 2 cases each.Conclusion: The hospital stay duration, operating time wascomparatively lesser with single layer technique. It was alsocost effective and easy to perform.

Application of evidence-based nursing in blind intubation of helico-nasointestinal tube in patients with stroke-associated pneumonia in intensive care unit / 中华临床营养杂志

Objective To study the effect of evidence-based nursing in patients with cerebral apoplexy in ICU by blind bedside spiral nasointestinal tube application.Methods To choose between September 2016 and September 2017 in our hospital ICU were 140 cases of patients with cerebral apoplexy as analysis object,randomly divided into two groups,two groups all use bedside blind spiral nose long intestinal tube technology,the control group using conventional nursing method for nursing,observation group using evidence-based nursing intervention,compared two groups of a success rate of catheter,accident to take off the tube (unscheduled decannulation rate),reflux hiccups,vomiting incidence of aspiration and patient satisfaction.Results The success rate of catheterization in the observation group was higher than that in the control group,and the incidence of accidental catheterization was lower than that in the control group.The incidence of reflux hiccup and vomiting aspiration was significantly lower than that in the control group,and the patient satisfaction was higher than that in the control group (all P＜0.05).Conclusion For patients with cerebral apoplexy in the ICU bed of blind plug spiral nasal bowel technology combined evidence-based nursing intervention,clinical effect is remarkable,improve the success rate of catheter,reduces the surprise success rate of tube,unscheduled tube drawing number,reduces the incidence of reflux hiccups,vomiting aspiration,improve patient satisfaction and quality of life.

Swallowed Oro-esophageal Tube: A Case Report / 대한연하장애학회지

Tube feeding is used to provide nutritional support to patients who have difficulty taking food orally. A nasogastric tube is commonly used for these patients but there are some complications. Therefore, the oro-esophageal tube feeding method was developed to avoid these disadvantages. A 33-year-old male with a history of right basal ganglia intracranial hemorrhage was admitted to the rehabilitation department for the treatment of dysphagia caused by a new onset left basal ganglia intracranial hemorrhage. After the videofluoroscopic swallowing study, the nasogastric tube feeding was changed to intermittent feeding via an oro-esophageal tube. Unfortunately, the patient swallowed the tube during insertion. Hence, an emergent endoscopy was performed for tube removal. This article reports a rare case of a patient who underwent oro-esophageal tube removal with an esophagogastroduodenoscopy after tube swallowing during insertion. The insertion of an oro-esophageal tube requires a careful approach after considering the cognitive function, muscle strength, and family education.

Effects of "Q" nose paste on fixing nasogastric tube / 中国实用护理杂志

Objective@#To investigate the effects of "Q" nose paste on fixing nasogastric tube.@*Methods@#Totally 167 patients with nasogastric tube were divided into the observation group(80 cases) and the control group(87 cases) by random digits table method.The observation group fixed nasogastric tube using "Q" nose paste,while the control group using "π" nose paste. The occurrence rate of pressure injury of nasal mucosa and nasogastric tube dislocation, nurses′ operation time of pasting, removing nose paste, the time intervals of exchanging nose paste were observed and compared between the two groups.@*Results@#The occurrence rate of pressure injury of nasal mucosa in the observation group was 0,and it was significantly lower than the control group 6.897% (6/87), the difference was statistic between the two groups (χ2=5.523, P<0.05). The nurses′ operation time of pasting and removing nose paste in the observation group was (18.99 ± 1.13), (10.20 ± 0.96) s, and they were significantly shorter than the control group (38.97 ± 1.28), (20.38 ± 1.30) s, the difference was statistic between the two groups (t=-106.521, -57.266, P<0.01). The time intervals of exchanging nose paste in the observation group was (3.78 ± 0.98) d, and it was significantly lower than the control group (2.07 ± 0.91) d, the difference was statistic between the two groups(t=11.628, P<0.05). There was no statistical difference in the rate of nasogastric tube dislocation between the two groups (P>0.05).@*Conclusions@#Application of "Q" nose paste in fixation of nasogastric tube can decrease the incidence of nasal mucosa pressure ulcers, it is conducive to extend the interval of nasal sticker replacement and improve work efficiency, thus is worthy of clinical application.

Eficacia de una intervención educativa para mejorar el conocimiento de las/os enfermeras/os sobre el sondaje gástrico en pediatría / Effectiveness of an educational intervention to improve nurses' knowledge on pediatric nasogastric intubation

Objetivo. Eficacia de una intervención educativa para mejorar el conocimiento de las/os enfermeras/os sobre el sondaje gástrico en pediatría. Métodos. Estudio multicéntrico cuasi experimental pre- y postest mediante intervención educativa teórica basada en la evidencia bibliográfica y la evaluación de su eficacia a los 4 meses. Resultados. Cuestionarios entregados: 1019. Válidos: 557 (54,66 %) pretest, 246 (24,14 %) postest. Las respuestas pre- y postest fueron que el riesgo implícito que conllevaba siempre el procedimiento había sido percibido por el 53,2 % y aumentó al 70,7 % (p < 0,001). El 4,3 % elegía el tamaño de la sonda gástrica (SG) mediante tablas y se elevó al 24,6 % (p < 0,001). La longitud de la SG por introducir medida mediante el método nariz-oreja-distancia media xifoides-ombligo (nose-ear-mid-umbilicus; NEMU, por sus siglas en inglés) ascendió del 34,2 % al 81,3 % (p < 0,001). La comprobación de la ubicación de la SG previa a su uso pasó del 73,1 % al 86,5 % (p < 0,001). La comprobación de los cinco correctos (paciente, medicamento, dosis, vía y hora) previa a la utilización de la SG aumentó del 85,6 % al 91 %. Como métodos de comprobación, mejoró la percepción de inseguridad de la auscultación del 11,7 % al 31,1 % (p < 0,001), y disminuyó su uso del 95,1 % al 81,6 %. Creció la percepción de seguridad de la medición del pH gástrico del 71,3 % al 91,1 % (p < 0,001), y aumentó su uso del 7,6 % al 54,3 % (p < 0,001). Conclusiones. La intervención educativa resultó eficaz para incrementar el conocimiento de enfermería sobre el sondaje gástrico pediátrico.

Objective. To establish the effectiveness of an educational intervention to improve nurses' knowledge on pediatric nasogastric intubation. Methods. Multicenter, quasi-experimental, pre- and post-test study using a theoretical educational intervention based on bibliographic evidence and assessment of its effectiveness after 4 months. Results. Delivered questionnaires: 1019. Valid questionnaires: 557 (54.66 %) pre-test and 246 (24.14 %) post-test. Pre- and post-test answers indicated that the implied risk always entailed by the procedure had been perceived by 53.2 % and then increased to 70.7 % (p < 0.001). Nasogastric (NG) tube size was chosen using tables by 4.3 % of participants, and increased to 24.6 % (p < 0.001). The length of NG tube to be inserted as measured by the nose-ear-midumbilicus distance (NEMU) method increased from 34.2 % to 81.3 % (p < 0.001). Confirmation of NG tube placement prior to use increased from 73.1 % to 86.5 % (p < 0.001). Confirmation of the five rights (patient, drug, dosage, route, and timing) prior to NG tube use increased from 85.6 % to 91 %. In relation to confirmation methods, the perception that auscultation was unsafe improved from 11.7 % to 31.1 % (p < 0.001), and its use reduced from 95.1 % to 81.6 %. The perception that the measurement of gastric pH was safe increased from 71.3 % to 91.1 % (p < 0.001), and its use rose from 7.6 % to 54.3 % (p < 0.001). Conclusions. The educational intervention was effective to increase nurses' knowledge on pediatric nasogastric intubation.

Application of nasogastric feeding tube placed by endoscopy to give enteral nutrient solution in the pediatric intensive diseases / 中华临床营养杂志

Objective To investigate the efficacy and safety of nasogastric feeding tube placed by endoscopy to give enteral nutrient solution in the pediatric intensive diseases.Methods A retrospective analysis of 30 children with serious illness who were given enteral nutrient solution through the nasogastric feeding tube placed by endoscopy from January 2013 to May 2016 in our hospital was conducted including 12 boys and 18 girls aging from 2 months to 14 years with the mean as (6.86±3.44) years old.Catheterization condition including catheter insertion time after hospitalization,catheter maintenance time,hospital stay and retention time after discharge,postoperative complications after catheterization,prognostic indications including anal exhaust and defecation time,blood urine amylase and returning to normal time,and changes of the indicators for nutrition including total protein,albumin,prealbumin,retinol binding protein were analyzed.Results Catheter insertion time after hospitalization was (16.13 ± 10.51) days,catheter maintenance time (21.35± 9.62) days,hospitalization time after catheterization (20.10±8.96) days and hospital stay (36.23± 14.20) days.10 cases (33.3％) maintained the catheter for (11.10±4.65) days after the discharge.The anal exhaust time was (2.84±3.32) days and the defecation time (4.55±3.35) days;The urinary amylase significantly deceased three days after catheterization compared with that of one day before catheterization (P =0.047);Serum total protein,albumin,prealbumin and retinol binding protein increased three days after catheterization compared with that of one day before catheterization,but the difference was not statistically significant (P＞0.05).5 children (17％) had complications including 3 children of abdominal distension and 2 children of vomiting.Conclusions Nasogastric feeding tube placed by endoscopy to give enteral nutrient solution in the pediatric intensive diseases can improve the intestinal and pancreatic function,recover their nutritional status to some extent and be controlled safely.However,the waiting time for catheterization and the hospital stay after catheterization are relatively long.The implementation of this technology and the awareness of its safety need be strengthened.

Esophageal Obstruction Caused by the Solidification of Residue of an Enteral Feeding Formula

The nutritional support of acutely ill patients is very important and early enteral nutrition is recommended. Feeding via the nasogastric route is used widely for its ease of access if the patient cannot maintain volitional food intake. If the position of the tip or side holes of the nasogastric tube (NGT) is above the gastroesophageal junction, there is the possibility of retention and solidification of the administered enteral feeding formula in the esophagus. Therefore, the tip of the NGT should be checked carefully; a chest radiograph to confirm its position can be considered, especially in patients with a higher risk of aspiration and gastroesophageal reflux. In addition, careful consideration of the risk factors that can trigger esophageal obstruction is required when feeding patients in the intensive care unit. This paper describes two unusual cases of esophageal obstruction caused by the solidification of residue of an enteral feeding formula.

Influence of Nasogastric Tubes on Swallowing in Stroke Patients: Measuring Hyoid Bone Movement With Ultrasonography

OBJECTIVE: To investigate the influence of a nasogastric tube (NGT) on swallowing simulated saliva in stroke patients. METHODS: Three groups of participants were enrolled into the study: group A (20 stroke patients with a NGT), a control group B (25 stroke patients without a NGT), and group C (25 healthy adults with no brain lesions or dysphagia). Participants swallowed 1 mL of water to simulate saliva. Patients in group A were tested twice: once with a NGT (group A1) and once after the NGT was removed (group A2). The distance of hyoid bone movement was measured by subtracting the shortest distance between the mandible and hyoid bone (S) from the distance at resting state (R) measured with ultrasonography. The degree of the movement was calculated by (R–S)/R. The trajectory area of hyoid bone movement (Area) and the interval between the beginning of hyoid bone movement and the moment of the shortest hyoid−mandible approximation (Interval) was calculated by a computer program. RESULTS: From group A: R–S and (R–S)/R of group A2 at 1.14±0.36 cm and 0.30±0.09 cm and were significantly greater than those of group A1 at 0.81±0.36 cm and 0.22±0.08 cm (p=0.009 and p=0.005). After removing the NGT as seen in group A2, R–S and (R–S)/R were improved to the level of those of group B at 1.20±0.32 cm and 0.30±0.09 cm (p=0.909 and p=0.997). The Area of group A2 was larger and the Interval of group A2 was shorter than those of group A1 though a comparison of these factors between A2 and A1 did not show a statistically significant difference. CONCLUSION: A NGT interferes with the movement of the hyoid bone when swallowing 1 mL of water in stroke patients though the movement is restored to normal after removing the NGT.

Effect of food improvement on the retention time of nasogastric tube in stroke patients with dysphagia / 中国实用护理杂志

Objective To explore the effect of food improvement on the retention time of nasogastric tube in stroke patients with dysphagia. Methods Sixty cases were assigned to the control group(30 cases) and the experimental group(30 cases) by random digits table method, the control group received routine nasogastric feeding, and the experimental group were given texture modified foods and thickened liquid to try to help them eating through the mouth. The feeding tube was pull out when the person in experimental group was capable of taking texture modified foods and thickened liquid without difficulty,while the tube was pull out when the person in control group was able to eat regular food and drink regular fluids. The retention time of nasogastric tube of two groups was compared. Results The retention time of nasogastric tube was(6.13±2.96)d in the experimental group and(18.93±7.58)d in the control group, there was significant difference (t =-8.162, P<0.01). Conclusions Food improvement can effectively shortenthe retention time of nasogastric tube in stroke patients with dysphagia.

Effect of enteral nutrition via a naso-gastric(intestinal) tube vs a percutaneous endoscopic gastrostomy/jejunostomy tube in patients after liver transplantation: a Meta analysis / 中华肝胆外科杂志

Objective To systematically review the effect of enteral nutrition via a naso-gastric (intestinal) tube (NG) vs a percutaneous endoscopic gastrostomy/jejunostomy (PEG/PEJ) after liver transplantation,and provide support for the selection of proper nutrition.Methods Pub Med,web of science,Cochrane Library (Jan,2018),CNKI,VIP and Wanfang Date were search until Jan,2018.Two authors independently assessed the trials for inclusion and extracted the data.Discrepancies were resolved in consultation with a third reviewer,about the research of retrospective study for the effects of enteral nutrition via NG vs PEG/PEJ after liver transplantation was performed and supplemented.Publication bias were evaluated,and Meta-analyses were conducted with RevMan5.3.Results 4 studies were collected,involving 430 patients.The Meta-analysis showed that starting time of enteral nutrition of PEG/PEJ was earlier than NG (MD =-1.77,95％ CI-1.83 to-1.70,P＜0.05).The average hospitalization time of PEG/PEJ was shorter than NG (MD=-2.88,95％CI-5.19 to-0.56,P＜0.05).The diarrhea incidence of PEG/PEJ was higher than NG (OR=1.66,95％CI 1.04 to 2.65,P＜0.05),and gastroesophageal reflux incidence of PEG/PEJ was lower than NG (OR=0.29,95％CI 0.12 to 0.66,P＜0.05).The gastric retention rate of PEG/PEJ was lower than NG (OR =0.26,95％ CI 0.14 to 0.41,P＜0.05).Dislocation incidence of PEG/PEJ was lower than NG (OR =0.06,95％CI 0.01 to 0.46,P＜0.05).The pneumonia incidence of PEG/PEJ tube was lower than NG (OR=0.59,95％CI 0.36 to 0.99,P＜0.05).There were no significant differences between PEG/PEJ and NG on indwelling time,occlusion,abdominal infection,acute renal insufficiency,and acute rejection reaction.Conclusion PEG/PEJ had earlier starting time of enteral nutrition,shorter hospitalization time,lower nutrition tube placement related complications such as gastric esophagus reflux,gastric retention,dislocation rate and lower incidence of pneumonia,but the incidence of diarrhea was higher.NG is the first choice after liver transplantation,and for patients with serious basic diseases,weak digestive function or digestive system disorders PEG/PEJ can be chosen.