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

A Comparison of Continuous VS. Bolus Nasogastric Tube Feeding for ICU Patients with Ventilator

周幸生(Shin-Shang Chou) ； 林玉如(Yu-Ru Lin) ； 黃意媜(E-Chan Huang) ； 吳麗芬(Li-Fen Wu)

《榮總護理》 20卷1期 (2003/03) Pp. 1-10

https://doi.org/10.6142/VGHN.20.1.1

摘要

本研究目的主要探討接受不同鼻胃管灌食方法之使用呼吸器重症病人，對於胃排空指數、肺吸入指標、以及氣管內管拔除成效的影響，以提供臨床建立安全有效鼻胃管灌食標準的實證依據。研究設計採單盲前、後測及對照組之準實驗設計。研究對象爲重症呼吸器使用鼻胃管灌食病人，共80位參與，控制組40位，實驗組40位。控制組接受持續性鼻胃管灌食方式，實驗表且接受間歇鼻胃管灌食方式。結果顯示重症呼吸器使用病人接受間歇鼻胃管灌食方式後進食量顯著高於接受持續鼻胃管灌食之控制組(p=.000)；胃殘餘量(p=.013)、痰液葡萄糖反應(p=.006)、X光診斷吸入性肺炎(p=.000)顯著低於控制組，氣管內管拔除成效顯著高於控制組(p=.004)。此結果證實間歇性鼻胃管灌食方式爲人胃排空指標較好，所獲得之熱量較高、肺吸入指標較低，氣管內管拔除成效高於接受持續鼻胃管灌食病人，住加護單位天數則較短(p=.045)。本研究結果提供間歇性鼻胃管灌食臨床研究證據，以爲未來加護中心重症病人採用鼻胃管灌食方式的參考，並可作爲建立臨床間歇性鼻胃管灌食標準的依據。

關鍵字

鼻胃管灌食 ； 呼吸器使用 ； 加護病房 ； 肺吸入

並列摘要

Purpose: This study was aiming to compare the efficacy/complication of continuous nasal gastric tube (NG) feeding vs. bolus NG feeding. It was hoped that the finding can help to build the evidence-based nursing in NG feeding.
Materials and Methods: Conducted at a 42-bed medical-surgical ICU, for 80 ICU patients aged above 20 y/o using ventilators with APACHE score ＞15, all needing NG feeding and randomly assigned to receive continuous feeding by pump or bolus feeding manually. Gastric emptiness index, aspiration pneumonia index were checked on the first day and the 7th day after NG feeding. Patients were followed up to the 28th day to document the length of stay in ICU and endotracheal extubation status.
Results: Patients receiving bolus feeding had higher feeding volume (p=.000), less gastric residual volume (p=.013), less glucose in sputum (p=.006) and less aspiration pneumonia diagnosed by X-ray (p=.000). At the 28th day, bolus feeding group patients had higher rate of extubation of endotracheal tube (p=.004), and the length of stay in ICU of bolus feeding group patients were significantly shorter than the continuous feeding group (p=.045).
Conc1usion: Bolus feeding in ICU provided the critically-ill patients with higher intake of nutrient and lower risk of aspiration pneumonia. Patients with bolus NG feeding had a better chance to be extubated and transferred out of ICU earlier, as compared to the continuous feeding. The result provides evidence to assist better nursing practice.

並列關鍵字

aspiration pneumonia ； nasal gastric tube NG feeding ； ICU ； ventilator