张丽峰 宋修响 孙华

【摘要】 目的：探討鼻道扩充器在胃癌患者术前鼻胃管置入中应用的效果。方法：选取需行胃癌根治术或胃大部切除术的胃癌患者82例，男47例，女35例，年龄36～77岁，ASAⅠ或Ⅱ级。采用随机数字表法，将患者随机分为对照组和试验组，每组41例。对照组采用传统方法留置鼻胃管，试验组采用鼻道扩充器扩充鼻腔并对鼻腔及咽喉部实施表面麻醉的方法留置鼻胃管。记录入室后5 min（T0）、鼻胃管过后鼻孔到达咽喉部即刻（T1）和插管成功即刻（T2）患者的MAP和HR;记录一次性置管成功率;记录患者恶心、呕吐、咳嗽及黏膜损伤等不良反应的发生率;记录者评价鼻胃管通过鼻腔时患者的舒适度评分。结果：与对照组比较，试验组T1和T2时间点的MAP和HR明显低，一次置管成功率高，不良反应发生率低，患者的舒适度明显高（P<0.05或P<0.01）;与T0比较，对照组T1和T2时间点的MAP和HR升高（P<0.01）。结论：鼻道扩充器在胃癌患者术前鼻胃管置入中应用可明显提高患者的舒适度和一次置管成功率，降低不良反应的发生，从而有效提高护理质量。

【关键词】 鼻道扩充器 鼻胃管置入 胃肿瘤

doi：10.14033/j.cnki.cfmr.2020.17.054 文献标识码 B 文章编号 1674-6805（2020）17-0-03

Application of Nasal Canal Dilator in Nasogastric Tube Placement for Patients with Gastric Cancer before Operation/ZHANG Lifeng， SONG Xiuxiang， SUN Hua. //Chinese and Foreign Medical Research， 2020， 18（17）： -128

[Abstract] Objective： To observe the effect of nasal canal dilator in nasogastric tube placement for patients with gastric cancer before operation. Method： A total of 82 patients with gastric cancer underwent radical gastrectomy or subtotal gastrectomy were collected， including 47 males and 35 females， aged from 36 to 77 years old， American society of anesthesiologist （ASA） grade Ⅰ or Ⅱ. The patients were divided into two groups （the control group and the experimental group） of 41 patients each according to random data table. The traditional method was used to retain the nasogastric tube in the control group， nasal cavity was expanded and the nasal cavity and pharynx and larynx were superficially anaesthetized with nasal canal dilator in the experimental group. The patients heart rate （HR） and mean artery pressure （MAP） were recorded at 5 minutes after entering the operation room （T0）， the instant that the nasogastric tube come to the throat after the nasogastric tube passes through the back nostrils （T1）， the instant of success in nasogastric tube placement （T2）， respectively. One time success of catheter， the incidence of adverse reactions such as nausea， vomiting， cough and mucosal injury were calculated and the patients comfort with nasogastric tube through nasal cavity were scored. Result： There were lower MAP and HR at T1 and T2 stage， higher one time success rate of catheterization， lower incidence of adverse reactions， and higher comfort score in the experimental group than those in the control group （P<0.05 or P<0.01）. Increases in MAP and HR occured at T1 and T2 stage in the control group compared with T0 （P<0.01）. Conclusion： The application of nasal canal dilator in nasogastric tube placement for patients with gastric cancer before operation can effectively improve the patient comfort and one time success rate of nasogastric tube intubation， reduce the incidence of adverse reactions， so then improve the quality of nursing.

[Key words] Nasal canal dilator Nasogastric tube placement Stomach neoplasms

First-authors address： Peoples Hospital of Jimo， Qingdao， Qingdao 266200， China

胃癌是严重危害我国居民健康的疾病，我国胃癌新发和死亡病例数都位于所有肿瘤的第二位[1]，目前手术仍然是胃癌的主要诊疗方法[2]。在二级医院胃癌手术前仍需常规置入鼻胃管，目的在于为术者提供一个良好的术野，并有助于减少术后腹胀、呕吐和肠梗阻等术后并发症。传统方法留置鼻胃管时患者较痛苦，恶心、呕吐等不良反应发生率高，胃管置入困难或误入气管诱发剧烈呛咳甚至缺氧的现象时有发生。笔者根据上呼吸道解剖结构特点发明了一种鼻道扩充器（专利号ZL201110462464.0），在置入鼻胃管前对患者鼻腔进行扩充和表面麻醉。……