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目的探讨一种利用胃管自带导丝引导更换神经危重症患者同侧鼻腔留置胃管的方法与效果。方法选择2016年1月至2016年12月100例在大坪医院神经内科需更换胃管的神经危重症患者,按随机数表法分为观察组52例,对照组48例。对照组采用常规方法更换胃管;观察组将新胃管导丝尾端接头剪掉,原胃管在距鼻腔外5 cm处剪断,利用导丝交换技术置入新胃管,即通过原胃管途径置入导丝,再将新胃管通过导丝置入原位置。比较两组患者的一次性置管成功情况、操作时间以及对更换胃管刺激的反应程度。结果观察组一次性置管成功率(92.3%)高于对照组(46.6%),操作时间观察组(9.87±1.91)min远低于对照组(23.23±4.58)min、观察组收缩压、心率、呼吸波动范围[(14.33±4.19)mm Hg、(16.91±6.23)次/min、(3.3±1.59)次/min]低于对照组[(24.10±5.26)mm Hg、(26.33±8.74)次/min、(5.6±2.44)次/min],对更换胃管的刺激如恶心、呛咳、呕吐发生率(5.8%、11.5%、0)低于对照组(33.3%、47.9%、12.5%),差异有统计学意义(P<0.05)。结论胃管自带导丝更换神经危重症患者同侧鼻腔留置胃管,操作简单,安全有效,不增加患者住院费用,可在临床推广应用。
Objective To explore a method and effect of guiding the replacement of gastric tube in ipsilateral nasal cavity with guide wire guided by gastric tube. Methods From January 2016 to December 2016, 100 patients with neurological critically ill patients who needed to change gastric tube in neurology of Daping Hospital were divided into observation group (n = 52) and control group (n = 48) according to random number table. In the control group, the gastric tube was replaced by the conventional method. In the observation group, the tail end of the new gastric tube guide wire was cut off. The original gastric tube was cut 5 cm away from the nasal cavity. The new gastric tube was inserted through the guide wire exchange technique, Tube approach into the guide wire, then the new gastric tube into the original position through the guide wire. The success of one-time catheterization, the operation time and the degree of response to gastric tube stimulation were compared between the two groups. Results The success rate of one-time catheterization (92.3%) in the observation group was significantly higher than that in the control group (46.6%). The operation time observation group (9.87 ± 1.91) min was much lower than that of the control group (23.23 ± 4.58) min. The systolic blood pressure (14.33 ± 4.19) mm Hg, (16.91 ± 6.23) / min, (3.3 ± 1.59) / min) were lower than those in the control group [(24.10 ± 5.26) mm Hg, (26.33 ± 8.74) The incidences of nausea, cough and vomiting (5.8%, 11.5%, 0) were lower than that of the control group (33.3%, 47.9%, 12.5% ), The difference was statistically significant (P <0.05). Conclusion Gastric tube with guide wire to replace the ipsilateral nasal cavity in patients with critically ill patients with neurological crisis, simple operation, safe and effective, does not increase the cost of hospitalization in patients with clinical application.