以實證探討鼻胃管灌食導致吸入性肺炎之預防措施

Preventing Nasogastric Tube Feeding Caused Aspiration Pneumonia: An Evidence-based Approach

鼻胃管灌食是吞嚥困難或是無法由口進食者預防肺吸入的方法，也是最方便且普遍的腸道營養支持方式。然而鼻胃管灌食最嚴重且常發生的合併症，卻也是吸入性肺炎。當胃殘餘量過多或鼻胃管錯位以及病人姿勢不適當時，容易導致嘔吐、食道逆流，口腔衛生不良會導致口咽菌落量增加，吞嚥困難者容易發生肺吸入的意外，而這些因素便會增加使用鼻胃管灌食者發生肺炎的風險。因此本文以實證方式探討鼻胃管灌食導致吸入性肺炎之預防措施，根據臨床照護指引及實證研究建議，採用正確的管灌技術，維持床頭大於30度的姿勢擺位，適當的鼻胃管位置，避免胃殘餘量大於200cc，以及灌食前抽痰和常規口腔衛生護理等方法，可以做為鼻胃管灌食患者預防肺炎的護理措施。最後本文發展出預防吸入性肺炎方案步驟建議，提供臨床實務參考。期望能減少鼻胃管灌食導致吸入性肺炎發生率以及增加營養支持。

Nasogastric tube feeding is a convenient and popular method of providing nutrients for individuals with difficulty swallowing or other contraindications to use oral route for nutritional support. Although it can help prevent aspiration pneumonia caused by dysphagia, serious complications caused by nasogastric tube feeding can also contribute to aspiration pneumonia.Excessive gastric residual volume, incorrect placement of the nasogastric tube, inappropriate posture, esophageal reflux with vomiting, and poor oral hygiene are amongst the risk factors for aspiration pneumonia. In this article, we explore evidence-based approaches to prevent nasogastric tube feeding caused aspiration pneumonia. Clinical practice guidelines and evidence-based research recommendations are used to reduce the risk of aspiration pneumonia include: confirming proper nasogastric tube placement, maintaining a posture of greater than 30 degrees of inclination, avoiding gastric residual volume greater than 200cc, suctioning before feeding, and a routinely oral hygiene care. We developed a protocol for preventing nasogastric tube feeding caused aspiration pneumonia in clinical setting. We hope the implementation of the protocol can help reduce the incidence of nasogastric tube feeding caused aspiration pneumonia and enhance nutritional support.