鼻胃管異位病例報告與文獻回顧

Misplacement of Nasogastric Tube: Case Report and Review of the Literature

王明(Ming Wang) ； 周教鵬(Yi-Peng Chou)

《Journal of Medical Sciences》 12卷3期 (1991/12) Pp. 207-210

摘要

雖然鼻胃管異位的案例報告相當少見，但此種意外若未及時發現及適當治療，則會導致嚴重的後果甚至危及性命。本病患是－62歲男性因上消化道出血在地方醫院治療失敗後轉至本院作進一步治療。住院期間病患接受剖腹探查及比耳洛氏胃十二指腸造口手術（Billroth gastroduodenostomy）。手術期間因插置鼻胃管失敗，手術後於麻醉恢復室重插入鼻胃管。不料病患逐漸出現呼服困難，心跳、血壓增高等生命徵候不穩定現象。經胸部X光照相檢查發現鼻胃管誤置於右肺支氣管中。隨後病患經硬食道鏡檢查發現病患亦罹患食道腫瘤併食道狹窄，導致鼻胃管插入困難及位置異常。插置鼻胃管雖然是一非常簡單的技術，而且臨床上亦有若干方法及準則可用來協助確定鼻胃管是否已插入胃中，但仍無法完全預防此種意外發生。故早期診斷發現乃治療此種意外的不二法門。本案例亦告訴我們當進行鼻胃管插入衛發生困難時，亦應考慮是否有食道解剖位置異常或病變存在的可能性。而且對鼻胃管插管困難的病患於插管後應該配合胸部X光檢查以確定鼻胃管的位置。

關鍵字

異位

並列摘要

There are two main indications for passing a nasogastric tube. One is to aspirate stomach contents, either for a diagnostic test or a therapeutic measure. The other is to maintain nutrition of the patient, either before treatment or after surgery. Misplacement of nasogastric tube has been reported infrequently. Similar cases in the literature are discussed. Common features of this complication are: (1) patents who are obrunded, debilitated or without gag reflex; (2) previous successful insertion of a tube; (3) successful passage of endotracheal tubes and tracheostomies; (4) positive auscultation of inflated air over the upper abdomen.Clinically, many methods can be used to check the position of nasogastric tube. However, complete prevention of this complication is impossible. Here, we reported a rare case. Literature was reviewed and guidelines of management were also discussed.

並列關鍵字

Misplacement ； Nasogastric