重型颅脑损伤患者床旁经鼻胃镜直视下放置空肠营养管的临床应用聂.DOC

重型颅脑损伤患者床旁经鼻胃镜直视下放置空肠营养管的临床应用 聂川 李政文 尧登华 何俊堂 吕黄勇 肖萧 解放军第59中心医院内镜中心，云南 开远，661600 [摘要] 重型颅脑损伤患者组织细胞代谢旺盛, 能量消耗增大，机体多处于负氮平衡状态。任何代谢紊乱或营养不良都可影响组织、器官功能，进一步恶化可致器官功能不全。对于颅脑损伤患者早期肠内营养（EEN）已成为现代标准治疗方案之一。常规的空肠营养管置入方法有盲插法、经口胃镜直视法（导丝法、异物钳法等）、X线/超声引导法等，成功率报道不一；对于重型颅脑损伤患者鼻肠管置入有较多难点，如开口困难、气管插管导致的食管入口狭窄、体位受限等，常规方法成功率更低。我中心自2009年5月-2011年12月对31例重型颅脑损伤患者行床旁经鼻胃镜直视下空肠营养管放置术，所有患者一次性成功放置，成功率100%，无并发症发生。安全性好,操作技术简单可行。 [关键词] 颅脑损伤；鼻胃镜；鼻肠管 Clinical observation of the nasojejunal tube placement by bedside transnasal gastroscope for patients of severe craniocerebral injury. NIE Chuan,LI Zhen-wen,YAO Den-hua,HE Jun-tang,LV Huang-yong,XIAO Xiao. The Center of Endoscopy,the 59thhospital of PLA.Yunnan Kai yuan,661600. Corresponding author:NIE Chuan,Email:nch_920@163.com [Absract] The patients of severe craniocerebral injury tissue metabolism, increased energy consumption, the body is in a negative nitrogen balance. Any metabolic disorders or malnutrition can affect the tissues, organs function, and further deterioration can lead to organ dysfunction. Early enteral nutrition (EEN) become one of the modern standard treatment program for patients of craniocerebral injury. Confventional method of nasojejunal tube placement conclude blind interpolation,endoscopy method (guidewire, forceps, etc.), the X-ray / ultrasound-guided method, the success rate reported mixed; The patients of severe craniocerebral injury with nasojejunal tube presence more difficulty, such as difficulty in opening mouth，esophageal inlet stenosis caused byTracheal intubation, position limited etc. conventional methods with low success rate. Our Center 31 patients of severe craniocerebral injury placed nasojejunal tube by bedside transnasal gastroscope since 2009.5- 2011.12.All patients with one-time successful placement, the success ratio were 100%,with no complication, The nasojejunal tube placement by bedside transnasal gastroscope is a safe method1,easy to operate1. [Key Words] Craniocerebral injury, Transnasal gastr