鼻胃管留置病人吸入性肺炎的預防照護

Preventive Care for Aspiration Pneumonia in Patients With an Indwelling Nasogastric Tube

吳尚蓉(Shang-Jung WU)

《護理雜誌》 69卷1期 (2022/02) Pp. 18-24

https://doi.org/10.6224/JN.202202_69(1).04

摘要

台灣超過19萬病人留置鼻胃管，鼻胃管是提供吞嚥障礙病人暫時或長期進食，及預防吸入性肺炎的一種處理方式，但吸入性肺炎也是鼻胃管留置常見的合併症。鼻胃管位置錯誤，鼻胃管放置長度過長或過短造成食物逆流，灌食姿勢及灌食速度不適當或胃殘餘量過多造成嘔吐，常是引起吸入性肺炎的原因。本文參考文獻及臨床實務經驗，針對鼻胃管置放長度及位置確認方法，在鼻胃管留置期間的口腔照護及灌食相關注意事項，包括：灌食時病人姿勢，灌食方法及胃殘餘量測量方法、頻率、暫停灌食評估進行敘述。期盼本文能供護理人員照護鼻胃管留置病人，預防其吸入性肺炎的參酌，以提升病人安全與照護品質。

關鍵字

鼻胃管留置 ； 吸入性肺炎 ； 胃殘餘量

並列摘要

More than 190,000 patients have been fitted with an indwelling nasogastric tube in Taiwan. Nasogastric tube feeding is a strategy for temporary or long-term feeding and for preventing aspiration pneumonia in patients with dysphagia. However, aspiration pneumonia is a common complication in patients fitted with a nasogastric tube. Displacement of the nasogastric tube, inappropriate length of the placed nasogastric tube resulting gastroesophageal reflux, inappropriate feeding posture and speed, and excessive gastric residual volume resulting in vomiting are important risk factors associated with aspiration pneumonia. In this article, the literature and clinical practice experiences were reviewed to identify methods used to confirm the length and positioning of nasogastric tubes. We further explored strategies for preventing oral-care and tube-feeding-induced aspiration pneumonia during the period of indwelling nasogastric tube. These strategies included adjusting the patient's positions for receiving tube feedings, feeding techniques, methods and frequency of gastric residual volume measurement, and conditions for stopping nasogastric feeding. This exploration was intended to provide nursing staff with relevant knowledge and skills for preventing aspiration pneumonia in patients with indwelling nasogastric tube to improve patient safety.

並列關鍵字

indwelling nasogastric tube ； aspiration pneumonia ； gastric residual volume

參考文獻

江月琇、林豐裕、高美菁、林瑞娥、吳尚蓉（2013）．鼻胃管插入後錯置偵測方法之系統文獻回顧．長期照護雜誌，17（2），105–124。[Jiang, Y.-X., Lin, F.-Y., Kao, M.-C., Lin, R.-A., & Wu, S.-J. (2013). A systematic review of methods for detecting nasogastric tube misplacement after Insertion. The Journal of Long-Term Care, 17(2), 105–124.]

Boeykens, K., Steeman, E., & Duysburgh, I. (2014). Reliability of pH measurement and the auscultatory method to confirm the position of a nasogastric tube. International Journal of Nursing Studies, 51(11), 1427–1433.

Chauhan, D., Varma, S., Dani, M., Fertleman, M. B., & Koizia, L. J. (2021). Nasogastric tube feeding in older patients: A review of current practice and challenges faced. Current Gerontology and Geriatrics Research, 2021, Article 6650675.

Chen, S., Xian, W., Cheng, S., Zhou, C., Zhou, H., Feng, J., Liu, L., & Chen, L. (2015). Risk of regurgitation and aspiration in patients infused with different volumes of enteral nutrition. Asia Pacific Journal of Clinical Nutrition, 24(2), 212–218. https://search.informit.org/doi/10.3316/informit.281716022868457

Chen, Y.-C., Wang, L.-Y., Chang, Y.-J., Yang, C.-P., Wu, T.-J., Lin, F.-R., Liu, S.-Y., & Wei, T.-S. (2014). Potential risk of malposition of nasogastric tube using nose-ear-xiphoid measurement. PLOS ONE, 9(2), Article e88046.