比較間歇性與連續性鼻胃管灌食法對呼吸器病人呼吸器相關肺炎及臨床指標的影響

Comparison of the effects of intermittent versus continuous enteral nasogastric feeding on ventilator-associated pneumonia and clinical outcomes for patients on mechanical ventilation

周劭蓉(Shao-Jung Chou)

指導教授 ： 楊麗玉

高雄醫學大學/護理學院/護理學系碩士班/碩士(2021年)

摘要

重症病人因疾病需求，常見使用鼻胃管經由腸胃道給予營養，又分為間歇性灌食、連續性灌食，其最常發生的合併症是由氣道吸入胃內容物，以致吸入性肺炎發生。尤其是重度顱內出血病人須持續使用鎮靜藥物，使得呼吸器相關肺炎發生率高於平均呼吸器相關肺炎發生率。目前臨床上針對使用呼吸器重症病人該使用何種鼻胃管灌食方式尚未有統一的標準。
本研究屬於觀察性研究，以台灣南部某醫學中心之腦神經外科加護病房共153位住院病人資料進行分析，藉由病歷回溯檢視連續性鼻胃管灌食與間歇性鼻胃管灌食兩組在人口學特性、呼吸器相關肺炎發生率、氣管內管使用天數及總住院天數、住院費用、死亡率等變項是否有差異。
研究結果顯示，與間歇性或連續性鼻胃管灌食二者在呼吸器相關肺炎發生率，以及住院天數及住院費用皆無顯著差異，但連續性鼻胃管灌食的病人其死亡率高於間歇性鼻胃管灌食病人(p=0.048)。連續性鼻胃管灌食可能死亡的機率是間歇性鼻胃管灌食可能死亡機率的2.183倍，以及若病人被診斷為呼吸器相關肺炎死亡率會提高(p=0.040)，死亡機率是未診斷呼吸器相關肺炎死亡機率的1.619倍。因此，對於使用呼吸器且須使用鼻胃管灌食之病人，依據病人所需熱量，考量時間及臨床照護人力，建議在急性後期即可改為間歇性鼻胃管餵食，及有效預防呼吸器相關肺炎，以降低死亡率。

關鍵字

呼吸器相關肺炎 ； 鼻胃管餵食 ； 神經外科 ； 呼吸器病人

並列摘要

Critically patients due to disease who need to have endotracheal intubation or tracheostomy maintained airway. The patient with endotracheal tube should use enteral nasogastric feeding to intake adequate nutrition. It was including two methods like intermittent enteral nasogastric feeding(IEF) and continuous enteral nasogastric feeding(CEF). The most common complication of enteral nasogastric feeding was pulmonary aspiration. It’s easy to have Ventilator-associated pneumonia(VAP) for the patient who conscious change, especially several intracerebral hemorrhage(ICH) cases who should keep in sedation. However, there have no standard for ventilated patients how to choose method of feeding.
This was a observational study. We enrolled total 153 patients in neurosurgery intensive care unit at a medical center in Southern Taiwan. From the chart review, we investigated that the association between population characteristics, the incidence of VAP, the days of ventilator, length of stay, hospitalization expenses and mortality rate among patients of ICH combined with intermittent enteral feeding(IEF) or continuous enteral nasogastric feeding(CEF).
The results show that there was not significant difference in the incidence of VAP, the days of ventilator, length of stay and hospitalization expenses between IEF and CEF. But, patients receiving CEF had higher mortality rate than patients receiving IEF(p=0.048). The mortality rate of CEF is 2.183 times as higher as the mortality rate of IEF. The study highlights that the method of nasogastric feeding can significantly impact on patient mortality rate. Furthermore, the mortality rate of the patients in VAP is 1.619 times as higher as the mortality rate of the patients in non-VAP. Therefore, the study suggested that receiving IEF is better than CEF for ventilated patients who need nasogastric feeding. Consider the nursing hours and clinical care loading, the patients can choose IEF in post-acute care to reduce the mortality rate.

並列關鍵字

ventilation-associated pneumonia ； nasogastric feeding ； ventilated patient ； neurosurgery

參考文獻

白玉珠、陳美娟、鄒茵茵、葉純宜、童惠芳、劉慧玲…柯秀錦(2014)‧建立使用呼吸器重症病人之臨床營養護理指引‧榮總護理，31(2)，144-157。https://doi.org/10.6142/VGHN.31.2.144

周幸生、林玉如、黃意媜、吳麗芬(2003)‧不同鼻胃管灌食方法對重症呼吸器使用病人照護成效之探討‧榮總護理，20(1), 1-10。 https://doi.org/10.6142/VGHN.20.1.1

許健威、陳垚生(2017)‧預防呼吸器相關性肺炎組合式照護‧內科學誌，28(1)，18-23。 https://doi.org/10.6314/JIMT.2017.28(1).04

衛生福利部疾病管制署(2021年01月21日)‧院內感染監視通報系統統計分析‧取自https://www.cdc.gov.tw/Category/MPage/4G8HuDdUN1k4xaBJhbPzKQ

衛生福利部疾病管制署(2017年04月11日)‧組合式照護:一、降低呼吸器相關肺炎組合式每日照護措施‧取自https://www.cdc.gov.tw/Category/ListContent/K20wqCzSTz_eSz3Yyk0m9w?uaid=7PgHAOZ_EeD2MEfIR8AjvQ#