- 期刊
使用呼吸器時改良式低容積間歇性鼻胃管灌食對預防肺吸入的成效
The Effect of Preventing Aspiration with Modified Low Volume Intermittent N-G Feeding in Ventilator Dependent Patients
摘要
本研究欲探討傳統式間歇性鼻胃管灌食與改良式低容積間歇性鼻胃管灌食，對慢性呼吸器依賴病人在灌食合併症與腸胃耐受性的差異。採單盲、前後測、交叉臨床實驗法，研究對象爲北部某區域醫院呼吸照護病房10位慢性呼吸器依賴病人，隨機分派至兩組。所有研究對象於第1天早上第一餐禁食，第二餐開始第一組研究對象先接受傳統式間歇性鼻胃管灌食，每日6-8次，共三天，然後再接受改良式低容積間歇性鼻胃管灌食五天。第二組研究對象則相反，先接受改良式低容積間歇性鼻胃管灌食三天，再接受傳統式間歇性鼻胃管灌食五天。研究對象於第一日早上9AM、第四日早上9AM、第九日早上9AM時使用四個工具評估病人的肺吸入指標、吸入性肺炎的臨床表徵、胃腸反應、胃排空指標。研究結果顯示，在胃排空指標之灌食總量，改良式低容積間歇性鼻胃管灌食比傳統式間歇性鼻胃管灌食多，而且達到統計上顯著性。在其他變項上，改良式低容積間歇性鼻胃管灌食與傳統式間歇性鼻胃管灌食後的差異很小或者未達統計上顯著意義。改良式間歇性鼻胃管灌食可以作爲慢性呼吸器依賴病人的灌食方式，以增加灌食總量。研究結果可提供臨床及居家照護，預防灌食合併症與增加腸胃耐受性的依據。
並列摘要
Backgrown: Aspiration pneumonia one of the major complications in ventilator dependent patients, may cost a lot on medical care. Aspiration of oral or/and gastric content is the leading risk factors of aspiration pneumonia which induces 39-60% mortality. The best model of nasal-gastric (NG) feeding to prevent aspiration pneumonia is still controversial because of heterogeneous patients group. In aged and long term bed-ridden patients, traditional bolus feeding (T-NG) increases the incidence of aspiration because of the smaller gastric volume (about 120-150 ml) and delayed emptying. The aspiration incidences relate to continue feeding could also be increased as well as traditional bolus feeding. It may be due to increasing abdominal pressure which caused by cough and movement of body during prolonged feeding time. We conducted this study to compare the clinical effect on aspiration of modified low volume intermittent NG feeding (M-NG) with traditional bolus feeding in long term ventilator dependent patients. Method: In crossover study, eleven long term ventilator-dependent patients were enrolled and randomly divided into two groups: (A) T-NG feeding for 3 days →M-NG feeding for 5 days; (B) M-NG feeding for 3 days →T-NG feeding for 5 days. Clinical data were taken on 4(superscript th) and 9(superscript th) day at 9AM early morning. Results: All of the respiratory target, the clinical aspiration symptom/sign, and the stomach emptying target revealed statistically non-significantly (P value＞0.05), but had beneficial trends on abdominal distention, intake volume, and aspiration index in M-NG group. Conclusion: The M-NG feeding is better than T-NG feeding, which had beneficial trends on food intake, gastric distention, thus preventing aspiration. The failure of statistical significance could be due to small patient number. A larger scale study should be enrolled in the further research.