茅彦　　汪莉莉　　徐玲玲

[关键词] 神经外科;肠内营养;鼻饲;误吸;预防护理

[中图分类号] R473.6          [文献标识码] B          [文章编号] 1673-9701（2021）14-0178-04

Analysis on the causes of aspiration and nursing measures in the patients with neurosurgical coma during nasal feeding

MAO Yan   WANG Lili   XU Lingling

Department of Neurosurgery， Eastern Branch of Ningbo Medical Center Lihuili Hospital， Ningbo   315040， China

[Abstract] Objective To study the causes of aspiration in gastrointestinal nutrition in the patients with severe head injury and coma and their preventive nursing measures. Methods Retrospective analysis was used to select patients with severe head injury who were admitted to our department from January 2018 to June 2019，including 82 patients with enteral nutrition. They were divided into aspiration group and non-aspiration group. The general data， the depth of gastric tube indwelling， the use of related drugs and the GCS score were compared between the two groups. The factors related to aspiration was identified. Results ①The GCS score， the use of gastric-protective drugs， the actual indwelling depth and the difference of gastric tube indwelling depth of two groups were statistically significant （P<0.05）. ②The results of multivariate Logistic regression analysis showed that the GCS score（β=-1.137， RR=0.321， P=0.001） and the difference of gastric tube indwelling depth （β=-0.898， RR=0.407， P=0.000） were independent factors influencing the occurrence of aspiration. The lower the GCS score，the smaller the difference in gastric tube indwelling depth， and the higher the possibility of aspiration. Conclusion The occurrence of pneumonia after aspiration seriously affects the prognosis of patients with severe head injury. A systematic analysis of the causes of aspiration and nursing measures have a significant effect on reducing the incidence of aspiration in the patients with nasal feeding.

[Key words] Neurosurgery; Enteral nutrition; Nasal feeding; Aspiration; Preventive nursing

隨着肠内营养（Enteral nutrition，EN）支持治疗的不断发展，人们对其认识越发深入，EN支持治疗已广泛应用于临床。EN在为患者提供营养物质的同时，还进行免疫调控、减轻氧化应激、维护胃肠的结构和功能、降低炎性反应[1-2]。重型颅脑损伤昏迷患者伴有不同程度的意识障碍，他们的营养支持在治疗中显得尤为重要，肠内营养可以抵消与危重疾病相关的代谢变化，这些变化会增加严重并发症和不良临床结果的风险[3]。胃肠内营养为主要营养方式，临床常对患者置入鼻胃管进行鼻饲，从而提高患者自身营养水平，临床上大多选择置入鼻胃管后鼻饲流质，操作便捷安全。在本科室的患者鼻饲过程中发现误吸是最严重的并发症，误吸后发生的肺炎对患者造成严重影响[4]，不仅是影响患者预后，更是危及生命。本研究对误吸的预防护理对策进行探讨，现报道如下。

1 资料与方法

1.1 一般资料

选取我科2018年1月至2019年6月收治的重型颅脑损伤患者，其中82例肠内营养患者，其中男62例，女20例，发生误吸16例，年龄13～92岁，误吸组平均年龄（50.93±13.23）岁，非误吸组66例，年龄（56.23±15.65）岁，所有患者均具有模糊、昏睡或昏迷等意识障碍，GCS评分为7～13分。

1.2 方法

1.2.1 鼻胃管置入的深度  本科使用的鼻饲管总长度90 cm，导管的头端有5个侧孔，神经外科的昏迷患者贲门有时未处于关闭状态，当鼻饲管置入的长度是置管前测量长度时，鼻饲管头端的侧孔有可能在贲门的上方，一旦鼻饲开始后患者出现呛咳容易发生反流误吸。……