不同鼻胃管灌食方法對重症呼吸器使用病人照護成效之探討

A Comparison of Continuous VS. Bolus Nasogastric Tube Feeding for ICU Patients with Ventilator

研究緣起及目的：呼吸器使用重症病人灌食問題處置的方法會影響病人營養攝取量，甚至病人的性命。安全有效提供足夠熱量，讓病人能有足夠能量恢復健康，減少病人因灌食方式的差異而增加合併症之產生及病人營養缺失延遲復元的成本，是臨床照護的重要議題。但對現行常用兩種之灌食方法對腸胃道不適應反應及肺部合併症相關研究仍缺乏報告。本研究目的主要探討接受不同鼻胃管灌食方法之使用呼吸器重症病人，對於胃排空指數、肺吸入指標、以及氣管內管拔除成效的影響，以提供臨床建立安全有效鼻胃管灌食標準的實證依據。研究方法與過程：研究設計採單盲前、後測及對照組之準實驗設計。研究對象為重症呼吸器使用鼻胃管灌食病人，共80位參與，控制組40位，實驗組40位。控制組接受持續性鼻胃管灌食方式，實驗組接受間歇鼻胃管灌食方式。研究工具包括腸道適應量表，痰液糖分試紙，資料於鼻胃管灌食24小時，第7天時收集胃排空指數及肺吸入指標，第28天收集氣管內管拔除成效及ICU住院天數。以卡方檢定及對數迴歸進行資料分析。研究發現與建議：結果顯示重症呼吸器使用病人接受間歇鼻胃管灌食方式後進食量顯著高於接受持續鼻胃管灌食之控制組(p=.000)；胃殘餘量(p=.013)、痰液葡萄糖反應(p=.006)、X光診斷吸入性肺炎(p=.000)顯著低於控制組，氣管內管拔除成效顯著高於控制組(p=.004)。此結果證實間歇性鼻胃管灌食方式病人胃排空指標較好，所獲得之熱量較高、肺吸入指標較低，氣管內管拔除成效高於接受持續鼻胃管灌食病人，住加護單位天數則較短(p=.045)。本研究結果提供間歇性鼻胃管灌食臨床研究證據，以為未來加護中心重症病人採用鼻胃管灌食方式的參考，並可作為建立臨床間歇性鼻胃管灌食標準的依據。

Purpose: This study was aimed to compare the efficacy/ complication of continuous nasal gastric tube (NG) feeding vs. bolus NG feeding.It was hope that the finding can help to build the evidence based nursing in NG feeding.Materials and Methods: Conducted at a 42 bed medical-surgical ICU, 80 ICU ventilator used with APACHE score >15, aged above 20 y/o, and needed NG feeding were randomly assigned to receive continuous feeding by pump or bolus feeding manually.Gastric emptiness index, aspiration pneumonia index were check on the first day, and the 7th day after NG feeding.Patients were followed up to 28th day to document the length of stay in ICU and endotracheal extubation status.Results: Patients receiving bolus feeding had higher feeding volume (p=.000), less gastric residual volume (p=.013), less glucose in sputum (p=.006) & less aspiration pneumonia diagnosed by X-ray (p=.000). At the 28th day, bolus feeding group patient had higher rate of extubation of endotracheal tube (p=.004), and the length of stay in ICU in bolus feeding group patient were significant shorter than the continuous feeding group (p=.045). Conclusion: Bolus feeding in ICU provided the critically-ill patient with higher intake of nutrient and with lower risk of aspiration pneumonia.Patients with bolus NG feeding had a better chance to be extubated and be transferred out of ICU earlier, as compared to the continuous feeding.The result provides evidence to assist better nursing practice.