中国临床营养杂志
中國臨床營養雜誌
중국림상영양잡지
CHINESE JOURNAL OF CLINICAL NUTRITION
2001年
2期
109-110
,共2页
宋伟庆%闫庆辉%贾汝梅%吴爱须%穆大力
宋偉慶%閆慶輝%賈汝梅%吳愛鬚%穆大力
송위경%염경휘%가여매%오애수%목대력
就2年来100例次液囊空肠导管应用体会进行介绍。Ⅰ型管是以鼻胃管作载体,空肠导管前端5cm依附在鼻胃管的槽内,两者合为一体,各自有开口。胃管同普通14号胃管,空肠导管长约115cm。空肠导管有两个外口。一个是空肠导管外口,作为滴注药物或营养物使用;一个是液囊导管的开口,仅作推注液体,让薄膜套胀成液囊使用。以两个橡皮环将鼻胃管与空肠导管套在一起。置管方法与置普通鼻胃管相同。Ⅰ型导管主要适用于食管、胃肠、肝、胆、胰、脾及急腹症等手术,同时需要胃肠减压。术中用3ml生理盐水将液囊充盈,此时两管自然分开,术者捏住液囊将导管送入空肠上段,术后早期行肠内营养。并可防患于未然,术后一旦出现并发症,如吻合口瘘、吻合口水肿、胆瘘、胰瘘等,可借助导管予以肠内营养支持和其它对症治疗。笔者曾对2例贲门癌术后吻合口瘘患者,长达30天和61天经导管行肠内营养支持治疗,直至瘘口完全愈合,避免了再行空肠造瘘术。一般情况下导管保留10~14天。我们认为以Ⅰ型液囊空肠导管取代鼻胃管最适宜,既有胃肠减压效果,又建立空肠通道。空肠导管细软、弹性好、耐腐蚀、创伤小又经济,病人普遍能耐受。Ⅱ型管是去掉鼻胃管的依附,单一空肠导管,也可用金属导丝支撑。主要用于非手术或无需胃肠减压的病人。置入方法同前,确认导管抵达胃腔后,再将导管向胃内输入25~35cm,然后固定,用泛影葡胺3ml充盈液囊,借助液囊体积和重力,在胃肠蠕动作用下或灌注促胃肠蠕动药物,导管可过入空肠。笔者曾用Ⅱ型管作小肠造影时观察,导管进入空肠时间一般15~20min,治疗吻合口瘘、肠外瘘、胆、胰瘘等疾病,置管后液囊管能否顺利进入空肠与其胃肠蠕动功能有关,也有始终停留在胃内。因此,我们建议,手术前以Ⅰ型空肠导管取代鼻胃管,非常必要。目前液囊空肠导管除了外科,其它如烧伤科、神经内外科、精神科、肿瘤放化疗科等凡需要管饲的病人,均可应用。也可用作小肠造影。笔者认为有实用价值,值得推广应用。
就2年來100例次液囊空腸導管應用體會進行介紹。Ⅰ型管是以鼻胃管作載體,空腸導管前耑5cm依附在鼻胃管的槽內,兩者閤為一體,各自有開口。胃管同普通14號胃管,空腸導管長約115cm。空腸導管有兩箇外口。一箇是空腸導管外口,作為滴註藥物或營養物使用;一箇是液囊導管的開口,僅作推註液體,讓薄膜套脹成液囊使用。以兩箇橡皮環將鼻胃管與空腸導管套在一起。置管方法與置普通鼻胃管相同。Ⅰ型導管主要適用于食管、胃腸、肝、膽、胰、脾及急腹癥等手術,同時需要胃腸減壓。術中用3ml生理鹽水將液囊充盈,此時兩管自然分開,術者捏住液囊將導管送入空腸上段,術後早期行腸內營養。併可防患于未然,術後一旦齣現併髮癥,如吻閤口瘺、吻閤口水腫、膽瘺、胰瘺等,可藉助導管予以腸內營養支持和其它對癥治療。筆者曾對2例賁門癌術後吻閤口瘺患者,長達30天和61天經導管行腸內營養支持治療,直至瘺口完全愈閤,避免瞭再行空腸造瘺術。一般情況下導管保留10~14天。我們認為以Ⅰ型液囊空腸導管取代鼻胃管最適宜,既有胃腸減壓效果,又建立空腸通道。空腸導管細軟、彈性好、耐腐蝕、創傷小又經濟,病人普遍能耐受。Ⅱ型管是去掉鼻胃管的依附,單一空腸導管,也可用金屬導絲支撐。主要用于非手術或無需胃腸減壓的病人。置入方法同前,確認導管牴達胃腔後,再將導管嚮胃內輸入25~35cm,然後固定,用汎影葡胺3ml充盈液囊,藉助液囊體積和重力,在胃腸蠕動作用下或灌註促胃腸蠕動藥物,導管可過入空腸。筆者曾用Ⅱ型管作小腸造影時觀察,導管進入空腸時間一般15~20min,治療吻閤口瘺、腸外瘺、膽、胰瘺等疾病,置管後液囊管能否順利進入空腸與其胃腸蠕動功能有關,也有始終停留在胃內。因此,我們建議,手術前以Ⅰ型空腸導管取代鼻胃管,非常必要。目前液囊空腸導管除瞭外科,其它如燒傷科、神經內外科、精神科、腫瘤放化療科等凡需要管飼的病人,均可應用。也可用作小腸造影。筆者認為有實用價值,值得推廣應用。
취2년래100례차액낭공장도관응용체회진행개소。Ⅰ형관시이비위관작재체,공장도관전단5cm의부재비위관적조내,량자합위일체,각자유개구。위관동보통14호위관,공장도관장약115cm。공장도관유량개외구。일개시공장도관외구,작위적주약물혹영양물사용;일개시액낭도관적개구,부작추주액체,양박막투창성액낭사용。이량개상피배장비위관여공장도관투재일기。치관방법여치보통비위관상동。Ⅰ형도관주요괄용우식관、위장、간、담、이、비급급복증등수술,동시수요위장감압。술중용3ml생리염수장액낭충영,차시량관자연분개,술자날주액낭장도관송입공장상단,술후조기행장내영양。병가방환우미연,술후일단출현병발증,여문합구루、문합구수종、담루、이루등,가차조도관여이장내영양지지화기타대증치료。필자증대2례분문암술후문합구루환자,장체30천화61천경도관행장내영양지지치료,직지루구완전유합,피면료재행공장조루술。일반정황하도관보류10~14천。아문인위이Ⅰ형액낭공장도관취대비위관최괄의,기유위장감압효과,우건립공장통도。공장도관세연、탄성호、내부식、창상소우경제,병인보편능내수。Ⅱ형관시거도비위관적의부,단일공장도관,야가용금속도사지탱。주요용우비수술혹무수위장감압적병인。치입방법동전,학인도관저체위강후,재장도관향위내수입25~35cm,연후고정,용범영포알3ml충영액낭,차조액낭체적화중력,재위장연동작용하혹관주촉위장연동약물,도관가과입공장。필자증용Ⅱ형관작소장조영시관찰,도관진입공장시간일반15~20min,치료문합구루、장외루、담、이루등질병,치관후액낭관능부순리진입공장여기위장연동공능유관,야유시종정류재위내。인차,아문건의,수술전이Ⅰ형공장도관취대비위관,비상필요。목전액낭공장도관제료외과,기타여소상과、신경내외과、정신과、종류방화료과등범수요관사적병인,균가응용。야가용작소장조영。필자인위유실용개치,치득추엄응용。
Recently scholars pay more attention on enteral nutrition(EN).Itis a pity that EN is not prevalent as expected.Sacciform jejunun was applied to 100 cases in clinical practice in our hospital.The catherer is made in Qinxin Medical Catherer Factory.There are two varying size of cateherer-Ⅰ and Ⅱ.Ⅰ catherer has two catherers linked togther,being fit for operations of stomach,liver,pancreatic,esoplagas etc.At the same time,haso-gastric suction is necessary.The saccalus is filled with 3ml NS during operation,then the two catherers are devided naturallyed.The catherer with saccicus is placed in jejunun.Postoperative earlier enteral nutrition support are applicated.EN are satisfy used iva jejunum catherers in complication such as fistula originate from surgical sutrre line,pancreatic,gall bladder et.In our hospital,two patients with oesophagoastric fistulas were treated with EN.They received EN support for 30 days and 61 days before the fistulas healed spontanealsly.The mean duration sacciform jejunum catherers in place before removal is 10 days to 14 days.We believe it is suitable nasogastrojejunal catherers be replaced by sacciform jejunum catherers,because it provide a path for EN and haso-gastric suction.Sacciform jejunum catherer is soft,antiseptic,nonivasive and economical and accepted by patiens generally.Ⅱ catherer is a single catherer withlout the afflitiated nosogastrojejunal,being fit for patients of nonoperation or haso-gastric suction,and the means being used is similar to Ⅰ catherer.It is 10 min to 20 min before Ⅱ catherer enter jejunum.Although easiness,it is nessary to replace nosogastrojejunal with Ⅰ catherer.Patients being suitable for using saciform jejunum cather come from the Gasteroin Surfical Department,Burn Department,veurolgy Department,radio therapy and Chemotherapy Department.Thus we think it shoule be applied wildly.