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Evaluation of Efficacy of Local Spraying Anaesthesis in Preoperative Implantation of Nasogastric Tube inPatients with Laryngeal Carcinoma

目的：比较常规鼻胃管置入法与鼻咽部局部喷雾麻醉后置胃管法对喉癌患者的影响。方法：将需要安置胃管的100例患者随机分成两组，每组50例。实验组行鼻咽部喷雾麻醉，对照组按常规操作，比较两组患者流泪、恶心、呕吐、咳嗽反应，一次成功率及插管所需要时间、插入中暂停次数。结果：实验组一次成功率高，患者反应轻，插管所需时间有显著差异。结论：常规置胃管常因病员难受而中途暂停置管，实验组置胃管前先作鼻咽部局部喷雾麻醉，可明显减轻患者的痛苦，提高插胃管的一次成功率，插管过程中因病员难受暂停次数也明显减少，使临床护理工作时间缩短，对临床护理工作有积极意义。

Establishment and Management of Enteral Nutrition Support in Critical Patients

小卡子在防止重症患者胃内容物外溢中的应用及效果

目的　总结和验证小卡子在防止危重患者肠内营养液及管喂药物后2 h内发生外溢的方法及效果。 方法　2011年5月－8月将ICU收治的80例需管喂的危重患者，随机分为两组，对照组采用传统的胃管末端盖子封闭胃管，试验组采取胃管远端加设小卡子夹闭胃管封闭法，比较两种方法在预防胃内容物外溢中的作用及效果。 结果　试验组患者无1例发生胃内容物外溢，两组比较差异有统计学意义（P＜0.05）。小卡子夹闭胃管可有效防止胃内药物或营养物质丢失。 结论　在胃管远端使用小卡子夹闭胃管的方法能有效降低胃内容物外溢发生率。

留置胃管拔管障碍一例

留置胃管患者非计划性自行拔管的相关因素分析及对策

摘要:目的:调查留置胃管患者在留置期间发生非计划性自行拔管的发生及相关因素,并探索护理对策。方法:调查218例留置胃管患者中非计划性自行拔管的发生情况,并分析导致非计划性自行拔管的相关因素。结果:在218例留置胃管患者中发生非计划性自行拔管 62例,小于45岁患者非计划性自行拔管发生率为39.5%,大于45岁患者非计划性自行拔管发生率为21.2%,前者高于后者并有显著性意义,癌症患者非计划性自行拔管发生率为36.4%,炎症(急性胰腺炎)疾病患者非计划性拔管为29%,其他疾病患者非计划性拔管为18.6%,癌症患者和急性重症胰腺炎高于后一组患者有显著意义,舒适的改变、约束不当、健康教育不到位、巡视不及时是造成非计划性拔管的。结论:对留置胃管患者心理护理应贯穿其患病的全过程,在操作前做好健康教育,手术患者应有效的固定肢体,对留置胃管造成的不适,给予对症护理,并增加护理人员加强巡视沟通,以减少非计划性自行拔管的发生。

Clinical Application of Nasogastric Tube in Perioperative Period of Colorectal Surgery

目的　探讨在结直肠手术围手术期中不常规应用鼻胃管的重要意义及其可行性。方法　选取2007年7月至2008年4月期间的结直肠手术患者40例，随机平均分为不留置鼻胃管和留置鼻胃管2组，记录２组各临床指标及并发症发生情况，并进行统计学分析。结果　不留置鼻胃管组患者舒适度增加，首次排气、排便及住院时间缩短（Plt;0.05），住院费用也相应降低（Plt;0.05），肺炎、肺不张、切口感染等并发症发生率低（Plt;0.05）。结论　结直肠手术不常规放置鼻胃管安全、可行，对减轻患者痛苦、减少术后并发症的发生率、缩短患者住院时间有重要意义。

改良后的胃管置入法临床应用及效果

目的观察改良后胃管置入法的临床应用效果。 方法对2012年10月－2013年5月收治的60例需置胃管患者按照就诊顺序分为对照组和改良组，每组30例。对照组采用传统胃管置入法，改良组采用改良胃管置入法。比较两组患者胃管置入过程中发生呛咳、误吸的情况及一次性置管成功率，胃管留置期间胃内容物反流、胃管滑脱发生情况。 结果改良组胃管置入过程中呛咳发生率低于对照组（6.7%、26.7%），一次性置管成功率高于对照组（93.3%、73.3%），差异有统计学意义（P＜0.05）；改良组置管舒适度优于对照组，差异有统计学意义（Z=-5.093，P＜0.001）；改良组胃管留置期间胃管脱管率低于对照组，差异有统计学意义（P＜0.05）。 结论改良胃管置入法能减少置入过程中患者发生呛咳情况，提高胃管置入成功率，降低胃管留置期间胃管脱管的发生率，值得在临床推广应用。

一次性胃管应用于肺叶切除术后胸腔闭式引流的临床研究

目的探讨采用一次性胃管作为肺癌肺叶切除术后引流管的疗效及护理。 方法将2014年1月－7月行肺癌肺叶切除术的60例患者随机均分为试验组和对照组，试验组应用一次性胃管作为胸腔引流管治疗，对照组应用常规硅胶管作为胸腔引流管治疗，对比分析两组患者的胸腔引流管堵塞情况、伤口疼痛程度、胸腔引流管拔管时间、胸腔引流管拔管后引流口渗液情况及术后平均住院时间。 结果两组患者的胸腔引流管均无堵塞。试验组患者伤口疼痛评分低于对照组；试验组平均拔管时间（2.43±1.36）d，对照组平均拔管时间（3.77±1.87）d；试验组4例（13.3%）拔引流管后引流口有渗液，对照组13例（43.3%）；试验组术后平均住院日为（3.50±1.38）d，对照组为（4.93±1.86）d；两组比较差异有统计学意义（P＜0.05）。 结论一次性胃管应用于肺癌肺叶切除术后胸腔闭式引流，材质柔软，患者疼痛减轻，方便离床活动，进一步促进伤口愈合和肺功能恢复，缩短拔管时间及术后平均住院时间，减轻患者经济负担。

Feasibility Analysis of Early Removing Nasogastric Tube Following Pancreaticoduodenectomy:A Retrospective Comparative Study of Homochronous Patients

ObjectiveTo assess the safety for removing nasogastric tube(NGT)within postoperative 24 h in Whipple pancreaticoduodenectomy (PD)patients. MethodsThe clinical data of 310 patients performed classic Whipple PD from January 2008 to March 2013 in this hospital were analyzed retrospectively. The patients were divided into early (≤24 h after operation)removing NGT group and late( > 24 h after operation)removing NGT group according to the time of NGT duration. The ratio of NGT reinsertion, time of solid diet tolerance, hospital stay, mortality, and major complications associated with PD were compared between two groups. Results①The demography and preoperative comorbidities characteristics were similar(P > 0.05).②There was no statistical difference of ratio of NGT reinsertion between two groups(P=0.450).③The differences of rates of major complications associated with PD and mortality were not statistically different(P > 0.05)by univariate analysis, but the rate of total complications in the early removing NGT group was significantly lower than that in the late removing NGT group (P=0.014)by multivariate analysis.④The average time of solid diet tolerance(P=0.013)and average hospital stay(P < 0.001)in the early removing NGT group were significantly shorter than those in the late removing NGT group. ConclusionFor patients comfort, NGT following PD should be removed as early as possible even immediately after extubation for selective patients.

A New Self-made Nasogastric Tube Fixation Device for Esophageal Cancer Patients after Esophagectomy

ObjectiveTo investigate clinical outcomes of a new self-made nasogastric tube (NGT) fixation device. MethodsFrom January 2012 to May 2013, 76 consecutive patients with esophageal cancer who underwent esophagectomy by a same surgical group in West China Hospital were included in this study. There were 62 male and 14 female patients with their average age of 60.7 years. Clinical outcomes of the NGT fixation device were prospectively evaluated from the operation day to patients' resumption of oral intake (usually 6 days postoperatively), or the time when NGT fell off accidentally or patients asked to exit this study. The main outcomes included whether NGT fell off, and caused or increased patients' discomfort. ResultsThe operation time of the 76 patients was 192±12 minutes. Postoperatively, 1 patient died of refractory pulmonary infection and respiratory failure before further treatment was refused by the patient and relatives. All the patients completed this study. There was no NGT falling off or severe patients' discomfort. Three patients complained obvious but tolerable face compression with mild discomfort. ConclusionsThis new fixation device can effectively prevent NGT from falling off. Further clinical trial is needed to investigate its clinical value.