經急診住院病人的鼻胃管放置情形與移除之相關因子

鼻胃管置放的常見原因為吞嚥困難或營養不良，然而在台灣針對住院病人群體的使用情形及移除因子，仍相對缺乏。本研究旨在探討台灣某醫學中心，因急性疾病住院病人的鼻胃管使用與移除情況的相關性。研究採用病歷回顧性設計，收錄2009年1月1日至2021年12月31日共62,987名經急診入院的內科病人醫療記錄。數據顯示，所有病人死亡率為9.0%，住院期間置放鼻胃管病人的死亡率，高於未置放鼻胃管病人(29.5% vs 3.9%, p<0.001)。在排除死亡病例後，40%的病人可於出院前移除鼻胃管。研究進一步分析發現，病況穩定後可促使鼻胃管移除的因素，包括年齡較大、住院期間禁食狀態較少、未接受物理治療，以及入院和出院時巴氏量表分數較高。這些因素顯示臨床不只是治療疾病本身，年長病人的營養調節、良好的日常生活功能，皆有助於鼻胃管的移除。這些結果可協助臨床人員，更有效地規劃使用與移除鼻胃管，並提升住院照護的品質。

Common reasons for nasogastric tube (NGT) placement include swallowing difficulties and malnutrition; however, in Taiwan, studies on its usage and removal factors among hospitalized patients remain limited. This study aims to explore the correlation between NGT usage and removal among inpatients admitted for acute conditions in a medical center in Taiwan. Utilizing a retrospective medical record review design, the study included medical records of 62,987 internal medicine patients admitted through the emergency department from January 1, 2009, to December 31, 2021. Data revealed an overall mortality rate of 9.0%, with the mortality rate of patients with NGT placement during hospitalization significantly higher than those without (29.5% vs. 3.9%, p<0.001). Excluding cases of mortality, 40% of patients had their NGT removed before discharge. Further analysis identified factors associated with NGT removal upon stabilization, including older age, fewer fasting periods during hospitalization, no physical therapy, and higher Barthel Index scores at both admission and discharge. These findings suggest that clinical care for elderly patients should focus not only on disease treatment but also on nutritional support and maintaining functional daily living abilities, which facilitate NGT removal. The results provide insights to help clinical staff more effectively plan NGT use and removal, thereby enhancing the quality of inpatient care.