A study of stress response to different ways of indwelling gastric tube in patients with severe craniocerebral injury / 中国中西医结合急救杂志

ABSTRACT

ObjectiveTo observe the effect on stress response to indwelling gastric tube assisted by bronchofiberoscope and traditional way in patients with severe craniocerebral injury in intensive care unit(ICU). Methods 126 patients admitted in Department of Surgery ICU in Lanzhou University Second Hospital were randomly divided into bronchofiberoscope assisted indwelling gastric tube group(experimental group) and the traditional way of indwelling gastric tube group(control group), 63 cases in each group. In the experimental group, the rod of mirror, Olypus BF-P60, was coated with lidocaine gel, through the nasal cavity it was sent into interior, when arrived at epiglottis, the operator adjusted the mirror head and let it go into the esophagus(about 10 cm), then put a steel wire as a guide into a hole for biopsy, and simultaneously, as the operator pulled out the rod, the wire was continuously pushed slowly further inside; after the bronchofiberoscope was completely withdrawn, valelinum liquidum was used to ensure sufficient lubrication to the external and internal walls of the indwelling gastric tube ready to be sent into the stomach, afterwards the tube was slowly pushed along the guide wire to an appropriate location and then the wire was pulled out, the operator injected air, when he or she heard the gurgling sound as the gas passing water, fixed the tube. In the control group, the traditional way of indwelling gastric tube was applied. Before and after indwelling gastric tube for 1, 3, 5 minutes, the changes of systolic pressure(SBP),diastolic pressure(DBP),heart rate(HR), end-expiratory carbon dioxide partial pressure(PETCO2) and plasma concentrations of norepinephrine(NE), adrenaline, angiotensinⅡ(AngⅡ), glucose(GLU) were examined.Results The plasma levels of SBP, DBP, HR, PETCO2, adrenaline, NE, AngⅡ and blood GLU had no statistical significant differences before operation in comparisons between both groups(allP>0.05). Compared to those before indwelling the tube, the levels of SBP, DBP, HR, PETCO2, NE, adrenaline, AngⅡ and GLU at various time points after the indwelling in experimental group were of no statisticalsignificant differences(allP>0.05), while the levels of SBP, DBP,HR, adrenaline, NE, AngⅡand GLU in control group at various time points after indwelling were higher obviously than those before operation, and the level of PETCO2 was decreased significantly compared with that before operation. The differences in the above indexes were significant between the treatment and control groups at 1 minute after indwelling〔SBP(mmHg, 1 mmHg=0.133 kPa) 125.1±15.4 vs. 135.5±13.6, DBP(mmHg) 85.6±16.1 vs. 91.1±17.2, HR(bpm) 99.4±13.8 vs. 107.9±16.5, PETCO2(mmHg) 32.5±2.8 vs. 29.8±4.1, NE(ng/L) 365.4±29.7 vs. 475.7±49.9, adrenaline(ng/L) 75.4±7.2 vs. 83.6±7.4, AngⅡ(ng/L) 65.3±6.9 vs. 73.3±9.1, GLU(mmol/L) 10.1±1.9 vs. 13.4±3.0, allP<0.05〕; the differences in the above indexes remained significant between the treatment and control groups till 5 minutes after indwelling〔SBP(mmHg) 123.7±14.8 vs. 129.7±15.1, DBP(mmHg) 84.3±14.6 vs. 88.4±14.2, HR(bpm) 97.7±13.6 vs. 31.6±3.9, PETCO2(mmHg) 33.5±3.1 vs. 31.6±3.9, NE(ng/L) 363.9±31.3 vs. 457.7±48.4, adrenaline(ng/L) 74.6±7.8 vs. 83.5±8.5, AngⅡ(ng/L) 64.3±8.4 vs. 71.9±5.9, GLU(mmol/L) 9.6±2.3 vs. 12.7±3.1, allP<0.05〕.ConclusionCompared with traditional way, the indwelling of gastric tube assisted by branchofiberoscopy can induce milder stress response.