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倒置胃管治疗残胃手术后食管癌一例

Evaluation of Efficacy of Local Spraying Anaesthesis in Preoperative Implantation of Nasogastric Tube inPatients with Laryngeal Carcinoma

目的：比较常规鼻胃管置入法与鼻咽部局部喷雾麻醉后置胃管法对喉癌患者的影响。方法：将需要安置胃管的100例患者随机分成两组，每组50例。实验组行鼻咽部喷雾麻醉，对照组按常规操作，比较两组患者流泪、恶心、呕吐、咳嗽反应，一次成功率及插管所需要时间、插入中暂停次数。结果：实验组一次成功率高，患者反应轻，插管所需时间有显著差异。结论：常规置胃管常因病员难受而中途暂停置管，实验组置胃管前先作鼻咽部局部喷雾麻醉，可明显减轻患者的痛苦，提高插胃管的一次成功率，插管过程中因病员难受暂停次数也明显减少，使临床护理工作时间缩短，对临床护理工作有积极意义。

留置鼻胃管位置判断方法应用及研究现状

针对目前国内外临床确认留置鼻胃管位置的方法，该文分析和总结了各国相关的指南或专家推荐，对检测依据、相关研究和国内外应用情况现状进行了综述，以期为临床护理工作者提供参考和借鉴。通过引进国外适用方法，应用于临床留置鼻胃管位置的正确判断，有利于保障患者鼻饲安全，减轻患者痛苦，减少不良事件的发生，促进护理质量的持续改进。

Effectiveness of Intranasal Lidocaine Spray before Nasogastric Tube Insertion: A Meta-analysis

ObjectiveTo systematically review the efficacy and safety of intranasal lidocaine spray before nasogastric tube insertion. MethodsWe searched PubMed, EMbase, The Cochrane Library, WanFang Data, VIP, CBM and CNKI databases concerning randomized controlled trial (RCT) of the efficacy and safety of intranasal lidocaine spray before nasogastric tube insertion from their inception to January 2014. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Meta-analysis was then conducted using RevMan 5.2 software. ResultsSix RCTs involving 384 patients were included. The results of meta-analysis showed that there were no significant differences between the lidocaine group and the saline group in pain and discomfort scores (MD=-25.35, 95%CI -30.37 to -24.33) and first successful insertion rate (RR=1.38, 95%CI 1.21 to 1.57). ConclusionIntranasal lidocaine spray before nasogastric tube insertion could reduce patient pain and discomforts related to the procedure, and improve the first successful insertion rate.

Chinese Herbal Enema plus Gastrointestinal Intubation for Ileus: A Systematic Review

ObjectiveTo systematically review the efficacy of Chinese herbal enema in ileus patients. MethodsThe randomized controlled trials (RCTs) and quasi-RCTs about Chinese herbal enema and gastrointestinal intubation versus western medicines in the treatment of ileus disease was searched in PubMed, Web of Science, EMbase, The Cochrane Library (Issue 4, 2013), CBM, CNKI, VIP and WanFang Data from the date of their establishment to July 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then meta-analysis was performed using RevMan 5.1. ResultsA total of 27 RCTs and 3 quasi-RCTs involving 3 074 patients were included. The results of meta-analysis showed that the Chinese herbal enema and gastrointestinal intubation group was superior to the control group in raising the total clinical effective rate (OR=4.69, 95%CI 3.70 to 5.94, P < 0.000 01), as well as shortening the hospitalization time (SMD=-1.19, 95%CI-1.42 to-0.96, P < 0.000 01), time of anus exhaust (SMD=-1.52, 95%CI-1.76 to-1.28, P < 0.000 01), defecation (SMD=-2.27, 95%CI-3.43 to-1.11, P=0.000 1), time of gastric tube indwelling (SMD=-1.56, 95%CI-1.86 to-1.27, P < 0.000 01), and symptoms complete resolution (SMD=-0.74, 95%CI-1.11 to-0.37, P < 0.000 1), all with significant differences. ConclusionChinese herbal enema and gastrointestinal intubation is more beneficial than western medicine alone for ileus. Due to limited quality of the included studies, the abovementioned conclusion still needs to be verified by conducting more high quality blinding RCTs.

一次性胃管应用于肺叶切除术后胸腔闭式引流的临床研究

目的探讨采用一次性胃管作为肺癌肺叶切除术后引流管的疗效及护理。 方法将2014年1月－7月行肺癌肺叶切除术的60例患者随机均分为试验组和对照组，试验组应用一次性胃管作为胸腔引流管治疗，对照组应用常规硅胶管作为胸腔引流管治疗，对比分析两组患者的胸腔引流管堵塞情况、伤口疼痛程度、胸腔引流管拔管时间、胸腔引流管拔管后引流口渗液情况及术后平均住院时间。 结果两组患者的胸腔引流管均无堵塞。试验组患者伤口疼痛评分低于对照组；试验组平均拔管时间（2.43±1.36）d，对照组平均拔管时间（3.77±1.87）d；试验组4例（13.3%）拔引流管后引流口有渗液，对照组13例（43.3%）；试验组术后平均住院日为（3.50±1.38）d，对照组为（4.93±1.86）d；两组比较差异有统计学意义（P＜0.05）。 结论一次性胃管应用于肺癌肺叶切除术后胸腔闭式引流，材质柔软，患者疼痛减轻，方便离床活动，进一步促进伤口愈合和肺功能恢复，缩短拔管时间及术后平均住院时间，减轻患者经济负担。

急性胰腺炎患者胃管留置中发生心搏骤停一例

两种鼻胃管的压疮发生率比较

目的比较两种不同材质鼻胃管的压疮发生率。 方法选择 2014 年 9 月—2015 年 9 月入住重症监护室符合纳入、排除标准的 180 例患者，根据其住院号尾数奇、偶分为对照组和试验组，每组各 90 例。对照组使用普通硅胶鼻胃管，试验组使用“复尔凯”鼻胃管。两组患者均使用 2.5 cm×7.0 cm 人字形 3M 易撕敷料胶带进行固定，面部采用 3M 透明敷料进行加强固定。观察两组患者鼻部压疮发生时间及发生率。 结果两组患者在带管 10 d 内均无鼻部压疮发生。带管 10～20 d，对照组 7 例患者发生压疮，压疮发生率为 7.8%；试验组无患者发生压疮，差异有统计学意义（P<0.05）。 结论“复尔凯”鼻胃管外径小，材质柔软，对于患者鼻部的刺激及挤压性较小，引起鼻部压疮发生较少，有利于减少患者鼻胃管相关的压疮发生率。

改良后的胃管置入法临床应用及效果

目的观察改良后胃管置入法的临床应用效果。 方法对2012年10月－2013年5月收治的60例需置胃管患者按照就诊顺序分为对照组和改良组，每组30例。对照组采用传统胃管置入法，改良组采用改良胃管置入法。比较两组患者胃管置入过程中发生呛咳、误吸的情况及一次性置管成功率，胃管留置期间胃内容物反流、胃管滑脱发生情况。 结果改良组胃管置入过程中呛咳发生率低于对照组（6.7%、26.7%），一次性置管成功率高于对照组（93.3%、73.3%），差异有统计学意义（P＜0.05）；改良组置管舒适度优于对照组，差异有统计学意义（Z=-5.093，P＜0.001）；改良组胃管留置期间胃管脱管率低于对照组，差异有统计学意义（P＜0.05）。 结论改良胃管置入法能减少置入过程中患者发生呛咳情况，提高胃管置入成功率，降低胃管留置期间胃管脱管的发生率，值得在临床推广应用。

Effect of 16F gastric tube as thoracic drainage tube on pain relief in patients after lung cancer resection: A controlled trial

Objective To explore the effect of 16F gastric tube on pain relief in postoperative lung cancer patients. Methods A total of 118 lung cancer patients were treated with radical resection of lung cancer in our hospital between January 2015 and May 2016. The patients were assigned into two groups: a 16F gastric tube group (16F group, 60 patients, 30 males and 30 females at age of 41-73 (52.13±7.83) years and a 28F drainage tube group (28F group, 58 patients, 25 males and 33 females at age of 45-75 (55.62±4.27) years. Clinical effects were compared between the two groups. Results There was no statistical difference in drainage time (4.47±1.03 dvs. 4.24±1.16 d, P=0.473), drainage amount (560.37±125.00 mlvs. 656.03±132.45 ml, P=0.478), incidences of pneumothorax (5/60 vs. 2/58, P=0.439), pleural effusion (6/60 vs. 3/58, P=0.522), and subcutaneous emphysema (3/60 vs. 1/58, P=0.635) between the two groups (P>0.05). The pain caused by the drainage tube in the16F group was less than that in the 28F drainage tube group with a statistical difference (F=4 242.996, P<0.001). The frequency of taking analgesics in the 16F group was significantly less than that in the 28F group (12/60vs. 26/58, P<0.001). Conclusion The effects of draining pleural effusions and promoting lung recruitment are similar between the 16F group and the 28F group. However, the wound pain caused by 16F gastric tube is significantly less than that by 28F drainage tube.