標準經鼻胃管置放術的修正：經口咽處操作導引法

A Modification of Standard Nasogastric Tube Insertion: Trans-oropharyngeal Manipulation Guiding Method

目的：臨床經常遇到經鼻胃管困難置放的患者，特別是在患者不能配合吞嚥動作、昏迷或是已插上氣管內管時。我們提出一個改良後的方法，有助於臨床醫護人員更能成功地進行鼻胃管置放術。方法：當鼻胃管到達患者口咽部時，右手食指與中指伸入患者口中，利用兩指尖端間的空間，把胃管直接送進食道入口，需製作防咬器避免被患者咬傷。結果：在2012年8月至2014年9月間，共有22名患者（12男10女）接受此方法，年齡67.1±16.0歲（平均值±標準差），僅有1人失敗須會診耳鼻喉科醫師以軟式纖維鼻咽喉內視鏡協助置入。結論：本文提出另一項經鼻胃管置放修正，過程中不需配合患者的吞嚥動作，尤其適用於功能性的吞嚥不良患者，做為標準方法失敗後的即時性選擇。

Purpose: In clinical practice, it is not uncommon patients with difficulties undergoing nasogastric tube insertion, especially those in a comatose state, having problems submitting to swallow, or receiving endotracheal intubation. This study accordingly proposed a modified method to render the procedure less difficultly and more successfully. Methods: As the gastric tube reached a patients oropharynx, the physician protruded his or her right middle and index fingers into the patients mouth, directly guiding and pushing the tube into the esophageal orifice. A bite block should be used to prevent the physician from being bitten by the patient. Results: From August 2012 to September 2014, the modified method was applied to 22 patients (12 men and 10 women) aged 67.1±16.0 (average±SD). Failure occurred in only one person for whom an otorhinolaryngologist was consulted to help complete the insertion with the aid of a fiberooptic nasopharyngoscope. Conclusion: This study introduces an alternative manipulation for nasogastric tube insertion, especially for those with functional dysphagia who could not submit to a standard method. The manipulation, modified from the known standard method, does not require the patient’s swallowing action.