Abstract: Background　Early enteral nutritional support therapy for critically ill patients has been widely used in clinical practice.After pyloric feeding through the nasal-jejunal nutrient tube，food reflux in gastric retention，aspiration and other complications can be effectively reduced.However，there is a certain difficulty in placing nasal jejunum nutrient tubes in clinical practice.How to find a quick and easy way to place nasal-jejunal nutrient tube is an urgent problem for clinicians to solve.Objective　To introduce a new method of catherterizing the nasojejunal tube by using "sandwich" method，and to evaluate its safety and clinical value.Methods　In this clinical study，we enrolled 234 patients who needed enteral nutrition therapy in the ICU of Affiliated Nanhua Hospital，University of South China during September 2015 to January 2017.Subjects were divided into endoscope group （51 patients），and “sandwich” group （183 patients）.In endoscope group，we inserted the nasojejunal tube with the assistance of endoscope，and in “sandwich” group，we performed air-nsufflation and wire-guided “sandwich” method.We assessed and compared the catherterizing time，success rate，complication rate and respiratory and cardiac data changes between two groups.Results　The average catheterization time in the “sandwich” group 〔（20±13）min〕 was shorter than that in the endoscope group 〔（24±7）min〕（t=-2.264，P=0.025）.There was no significant difference in the success rate of catheterization between two groups 〔96.7%（177/183） vs 100.0%（51/51），χ2=0.655，P=0.418〕.The complication rate of the “sandwich” group was lower than that of the endoscope group 〔13.1%（24/183） vs 78.4%（40/51），χ2=85.636，P<0.001〕.Heart rate，respiration and systemic pulse oximetry saturation （SpO2） of two groups before catheterization showed no significant difference （P>0.05）.However，the mean arterial pressure （MAP） in the “sandwich” group was higher than that in the endoscope group （P<0.05）.SpO2 of two groups after catheterization showed no significant difference （P>0.05）.However，the heart rate，respiration and MAP in the “sandwich” group were lower than those in the endoscope group （P<0.05）.SpO2 in the endoscope group before and after catheterization showed no significant difference （P>0.05）.However，the heart rate，respiration and MAP in the endoscope group after catheterization were higher than those before catheterization （P<0.05）.There was no statistically significant differences in MAP in the “sandwich” group before and after catheterization（P>0.05）.However，the heart rate，respiration and SpO2 in the “sandwich” group after catheterization were higher than those before catheterization （P<0.05）.Conclusion　The “sandwich” method can shorten the catheterization time，and reduce the occurrence rate of complication.The “sandwich” method is safe，efficient and has less adverse effect on cardiopulmonary function，which is worthy of clinical promotion.

Key words: Enteral nutrition；Intubation, gastrointestinal；Intensive care units

摘要： 背景　危重患者早期肠内营养支持治疗，已逐渐广泛应用于临床。通过鼻空肠营养管进行幽门后喂养能够有效减少胃潴留食物反流、误吸等并发症。但放置鼻空肠营养管在临床中存在一定难度，如何找到一个快速、简便放置鼻空肠营养管方法是临床医师需要迫切解决的问题。目的　介绍重症患者采用“三明治”法盲插鼻空肠营养管建立肠内营养途径的新方法，并探讨其安全性及临床价值。方法　选择2015年9月—2017年1月南华大学附属南华医院重症医学科收治的需要行肠内营养治疗并由同一医师实施鼻空肠营养管置管术的234例重症患者，根据治疗方法分为内镜辅助组51例，“三明治”法组183例，内镜辅助组采用内镜辅助鼻空肠营养管置管术，“三明治”法组采用注气联合导丝辅助体位“三明治”法盲插鼻空肠营养管。观察和比较两组患者置管时间、置管成功率、并发症发生率及置管前后心肺功能指标变化。结果　“三明治”法组患者平均置管时间〔（20±13）min〕短于内镜辅助组〔（24±7）min〕（t=-2.264，P=0.025）。两组患者置管成功率比较，差异无统计学意义〔96.7%（177/183）与100.0%（51/51），χ2=0.655，P=0.418〕。“三明治”法组患者总并发症发生率低于内镜辅助组〔13.1%（24/183）与78.4%（40/51），χ2=85.636，P<0.001〕。置管前两组患者心率、呼吸、血氧饱和度（SpO2）比较，差异无统计学意义（P>0.05）；置管前“三明治”法组患者平均动脉压（MAP）高于内镜辅助组（P<0.05）。置管后两组患者SpO2比较，差异无统计学意义（P>0.05）；置管后“三明治”法组患者心率、呼吸、MAP低于内镜辅助组（P<0.05）。内镜辅助组患者置管前后SpO2比较，差异无统计学意义（P>0.05）；内镜辅助组患者置管后心率、呼吸、MAP较置管前升高（P<0.05）。“三明治”法组患者置管前后MAP比较，差异无统计学意义（P>0.05）；“三明治”法组患者置管后心率、呼吸、SpO2较置管前升高（P<0.05）。结论　“三明治”法盲插鼻空肠营养管建立重症患者肠内营养途径可缩短置管时间、减少并发症发生率，安全、高效、快速，且对患者心肺功能影响较少，值得在临床推广。

关键词: 肠内营养, 插管法, 胃肠, 重症监护病房