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目的探讨自制角度指示器对准确调节综合ICU鼻饲患者床头角度减少误吸的效果情况。方法分析2014年1月~2015年1月温州医学院附属苍南医院收治的需要鼻饲给予营养的80例患者临床资料,依据抬高床头方法不同进行分组。对照组(40例)采用目测评估法抬高床头,观察组(40例)采用自制角度指示器准确抬高床头。比较两组鼻饲患者吸入性肺炎发生率、胃排空时间、总住院时间、需要进行鼻饲时间、误吸发生率情况;两组鼻饲患者治疗前后Ig A、Ig E、Ig G水平;两组鼻饲患者预后营养指数(PNI)。结果观察组鼻饲患者吸入性肺炎发生率(0%)、胃排空时间[(3.5±1.0)h]、总住院时间[(10.6±4.0)d]、需要进行鼻饲时间[(7.5±3.5)d]、误吸发生率(0%)均优于对照组[10%、(5.6±1.5)h、(20.5±5.6)d、(12.5±5.0)d、10%],差异均有统计学意义(P<0.05)。对照组和观察组鼻饲患者治疗前Ig A[(45.4±15.4)比(46.2±16.8)mg/d L]、Ig E[(20.2±4.5)比(21.3±4.6)U/m L]、Ig G[(5.6±3.2)比(5.9±3.5)g/L]比较,差异无统计学意义(P>0.05);对照组治疗后Ig A[(70.5±40.1)mg/d L]、Ig E[(71.7±40.4)U/m L]、Ig G[(9.7±3.9)g/L]均优于同组治疗前,观察组治疗后Ig A[(150.8±52.3)mg/d L]、Ig E[(110.4±50.2)U/m L]、Ig G[(13.3±4.0)g/L]均优于同组治疗前和对照组治疗后,差异有统计学意义(P<0.05)。观察组鼻饲患者PNI基本正常(45.0%)、轻度危险(45.0%)患者比例均高于对照组(30.0%、22.5%),差异有统计学意义(P<0.05)。结论应用自制角度指示器准确调节综合ICU鼻饲患者床头角度可以降低并发症发生率,提高机体免疫功能和PNI,值得临床推广应用。
Objective To explore the effect of self-made angle indicator on accurately adjusting the bedside angle of patients with nasal feeding in ICU to reduce aspiration. Methods From January 2014 to January 2015, clinical data of 80 patients who needed nutrition for nasal feeding admitted to Cangnan Hospital Affiliated to Wenzhou Medical College were divided into groups according to the method of raising headboard. The control group (40 cases) used the visual evaluation method to raise the bed head. The observation group (40 cases) used the self-made angle indicator to accurately raise the bed head. The incidence of aspiration pneumonia, gastric emptying time and total length of hospital stay were compared between the two groups. The nasal feeding time and the incidence of aspiration were compared. The levels of Ig A, Ig E and Ig G before and after treatment were compared between the two groups. Nasal feeding Patient prognostic nutritional index (PNI). Results The nasogastric feeding time [(7.5 ± 3.5) days) in nasal feeding patients in observation group was significantly higher than that in nasal feeding patients (0%), gastric emptying time [(3.5 ± 1.0) h] and total length of stay [(10.6 ± 4.0) d], and the incidence of aspiration (0%) were better than that of the control group [10% (5.6 ± 1.5) h, (20.5 ± 5.6) days, (12.5 ± 5.0) days, 10% Significance (P <0.05). Ig A [(45.4 ± 15.4) vs (46.2 ± 16.8) mg / d L], Ig E [(20.2 ± 4.5) vs (21.3 ± 4.6) U / m L] G (5.6 ± 3.2) vs (5.9 ± 3.5) g / L], there was no significant difference between the two groups (P> 0.05) [(71.7 ± 40.4) U / m L] and Ig G [(9.7 ± 3.9) g / L] were better than those before treatment in the observation group. IgA [(150.8 ± 52.3) mg / dL] Ig E [(110.4 ± 50.2) U / m L] and Ig G [(13.3 ± 4.0) g / L] were significantly higher than those in the control group before and after treatment (P <0.05). The PNI in observation group was basically normal (45.0%) and mild (45.0%) were higher than that in control group (30.0%, 22.5%), the difference was statistically significant (P <0.05). Conclusion Using self-made angle indicator to accurately adjust the bed angle of ICU nasal feeding patients can reduce the incidence of complications, improve immune function and PNI, worthy of clinical application.