CAJ | 학술논문

目的：比较常规置管法联合促动力药物、X线辅助及内镜辅助3种方法放置螺旋型鼻空肠管建立重度急性胰腺炎患者肠内营养的效果。方法45例重度急性胰腺炎患者分别采用常规置管法联合促动力药物、X线辅助和内镜辅助法放置鼻空肠管建立肠内营养，每组15例。比较3组患者置管成功率和并发症发生情况、置管前、中、后舒适度（VAS评分）以及营养管平均留置时间。结果3种置管方法的置管成功率、置管时并发症（如鼻咽部出血、上消化道出血、穿孔，误吸、呼吸困难等）发生率、置管远期并发症（如鼻窦炎、咽炎、鼻肠管移位、肺部感染等）发生率、营养管平均留置时间差异均无统计学意义（P>0.05）。常规置管法较X线辅助法和内镜辅助法的VAS评分低（P<0.05），常规置管法的并发症发生率较低（P<0.05）。结论常规置管法、X线辅助法和内镜辅助法均是重度急性胰腺炎病人早期放置鼻空肠管的安全、可行方法。常规置管法可作为一般病人的首选方法，其并发症少，特别有利于后期营养支持治疗及疾病康复；对实施机械通气、持续血液滤过治疗或十二指肠狭窄、并发胰性脑病的重度急性胰腺炎病人，首选内镜辅助法。
목적：비교상규치관법연합촉동력약물、X선보조급내경보조3충방법방치라선형비공장관건립중도급성이선염환자장내영양적효과。방법45례중도급성이선염환자분별채용상규치관법연합촉동력약물、X선보조화내경보조법방치비공장관건립장내영양，매조15례。비교3조환자치관성공솔화병발증발생정황、치관전、중、후서괄도（VAS평분）이급영양관평균류치시간。결과3충치관방법적치관성공솔、치관시병발증（여비인부출혈、상소화도출혈、천공，오흡、호흡곤난등）발생솔、치관원기병발증（여비두염、인염、비장관이위、폐부감염등）발생솔、영양관평균류치시간차이균무통계학의의（P>0.05）。상규치관법교X선보조법화내경보조법적VAS평분저（P<0.05），상규치관법적병발증발생솔교저（P<0.05）。결론상규치관법、X선보조법화내경보조법균시중도급성이선염병인조기방치비공장관적안전、가행방법。상규치관법가작위일반병인적수선방법，기병발증소，특별유리우후기영양지지치료급질병강복；대실시궤계통기、지속혈액려과치료혹십이지장협착、병발이성뇌병적중도급성이선염병인，수선내경보조법。
Objective To compare the nutritional effects for patients with severe acute pancreatitis (SAP) by conventional nasoenteric feed tube placement plus gastroprokinetic agent, nasojejunal feeding tube placement guided by endoscopic or radiological assistance. Methods A total of 45 SAP patients were included and divided into three groups by giving different tube placement described above(n=15 for each group). The three groups were compared pertaining to the success rate of tube insertion, incidence of complications, degree of comfort before, intra-and post-insertion of the feeding tube(VAS scoring) and average retention time of the tube. Results There was no statistical difference among the three groups regarding the success rate of tube insertion, incidences of immediate and long-term complications(including nasopharyngeal bleeding, gastroin?testinal bleeding, perforation, aspiration and dyspnea; pharyngitis, sinusitis, tube displacement and pulmonary infection) and average time of tube retention. However, insertion of the tube by c onventional technique had lower VAS scoring and fewer complications than endoscopic or radiological assistance (P<0.05). Conclusion Conventional nasoenteric feed tube placement and nasojejunal feeding tube placement with endoscopic or ra?diological assistance can be safe and reliable for patients with severe acute pancreatitis. Yet conventional tube placement should be prioritized, for it has fewer complications and favors to nutritional support and recovery, whereas endoscope-guided insertion of the feed tube is recommended for SAP patients required mechanical ventilation and continuous hemofiltration or complicated with pancreatic encephalopathy or duodenal stenosis.