肠内营养指南中鼻胃管位置判断方法的质量评价
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摘要
目的对肠内营养指南中鼻胃管位置判断方法进行评价,比较不同检测方法的差异,为临床使用及标准制订提供参考。方法计算机检索PubMed、EMbase、中国生物医学文献服务系统、万方数据库、中国知网,检索时限均为建库至2017年5月,并检索相关指南网站。由2名研究者按照纳入与排除标准独立筛选指南,并采用临床指南研究与评价系统Ⅱ评价指南的制订和报告质量。结果最终纳入6篇临床指南,其中英国2篇、美国2篇、新加坡1篇、中国1篇。纳入的指南在临床指南研究与评价系统Ⅱ各领域平均得分依次为:清晰性98.60%、范围与目的87.00%、应用性58.70%、严谨性48.95%、参与人员28.25%和独立性6.24%。其中4篇为B级推荐,2篇为C级推荐。结论指南推荐内容较为一致且互相补充,国内教科书中推荐使用的听诊气过水声、气泡试验及抽取胃液的方法已不推荐使用。国内本土化指南数量较少,需将国内临床现状与国外指南相结合,进一步发展和完善符合国内的指南。
Objective To systematically evaluate quality of clinical guidelines on identifying the position of naso-gastric tube in enteral nutrition,and to provide references for clinical practice by comparing different methods.Methods Relevant guidelines were electronically searched in PubMed,EMbase,CBM,WanFang Data,and CNKI(from inception to May 2017),and guideline websites were also searched. The screening process was conducted by two reviewers independently according to the inclusion and exclusion criteria,and quality of guidelines was appraised using the Appraisal of Guidelines for Research and Evaluation(AGREE Ⅱ). Results Six guidelines were included,and two were developed by the UK,two by the USA,one by Singapore,and one by China. The scores of guidelines according to the domains of AGREE Ⅱ decreased from clarity of presentations(98.6%),scope and purpose(87%),applicability(58.7%),rigour of development(48.95%),participants(28.25%)and independence(6.25%).The levels of recommendations were Level B(4 guidelines),Level C(2 guidelines). Conclusion The recommendations were consistent and complementary to each other. Methods including auscultation,bubble test and withdrawal of gastric juice were no longer recommended. The number of guidelines in China is relatively small,and it is necessary to combine domestic clinical situation and foreign guidelines to further promote guidelines in line with China's specific circumstances.
Objective To systematically evaluate quality of clinical guidelines on identifying the position of naso-gastric tube in enteral nutrition,and to provide references for clinical practice by comparing different methods.Methods Relevant guidelines were electronically searched in PubMed,EMbase,CBM,WanFang Data,and CNKI(from inception to May 2017),and guideline websites were also searched. The screening process was conducted by two reviewers independently according to the inclusion and exclusion criteria,and quality of guidelines was appraised using the Appraisal of Guidelines for Research and Evaluation(AGREE Ⅱ). Results Six guidelines were included,and two were developed by the UK,two by the USA,one by Singapore,and one by China. The scores of guidelines according to the domains of AGREE Ⅱ decreased from clarity of presentations(98.6%),scope and purpose(87%),applicability(58.7%),rigour of development(48.95%),participants(28.25%)and independence(6.25%).The levels of recommendations were Level B(4 guidelines),Level C(2 guidelines). Conclusion The recommendations were consistent and complementary to each other. Methods including auscultation,bubble test and withdrawal of gastric juice were no longer recommended. The number of guidelines in China is relatively small,and it is necessary to combine domestic clinical situation and foreign guidelines to further promote guidelines in line with China's specific circumstances.
引文
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[2]Willcox J.Nasogastric tube insertion[J].Foundation Years,2009,5(37):13-15.
[3]邵鹏,陈敏.肠内营养支持的研究进展[J].中华现代护理杂志,2012,18(13):1605-1607.
[4]葛津津,刘薇群,汤培凤,等.鼻胃管位置判断研究进展[J].解放军护理杂志,2015,32(19):37-39.
[5]Xu Z,Li W.Reminder of important clinical lesson:aspiration pneumonia caused by inadvertent insertion of gastric tube in an obtunded patient postoperatively[J].BMJ Case Rep,2011,2011(Nov 08 1):1-3.
[6]Hensel M,Marnitz R.Pneumothorax following nasogastric feeding tube insertion:case report and review of the literature[J].Anaesthesist,2010,59(3):229-234.
[7]Sellers CK.False-positive p H aspirates after nasogastric tube insertion in head and neck tumour[J].BMJ Case Rep,2012,2012(Aug 27 1):1-3.
[8]National Patient Safety Agency.Reducing the harm caused by misplaced nasogastric feeding tubes in adults,children and infants[EB/OL].(2011-03-10)[2017-12-01].http://www.nrls.npsa.nhs.uk/resources/?entryid45=129640&p=4.2011.
[9]National Nurses Nutrition Group.Safe insertion and ongoing care of nasogastric(NG)feeding tube in adults[EB/OL].(2016-04-01)[2017-12-01].http://www.nnng.org.uk/wp-content/uploads/2016/06/NNNG-Nasogastric-tube-Insertion-and-Ongoing-Care-Practice-Final-Aprill-2016.pdf.
[10]American Association of Critical-Care Nurses.Initial and ongoing verification of feeding tube placement in adults[J].Crit Care Nurse,2016,36(2):e8-e13.
[11]Bankhead R,Boullata J,Brantley S,et al.Enteral nutrition practice recommendations[J].J Parenter Enteral Nutr,2009,33(2):122-167.
[12]Ministry of Health.Nursing man agement of nasogastric tube feeding in adult patients[EB/OL].(2010-07-01)[2017-12-01]https://www.moh.gov.sg/content/dam/moh_web/HPP/Nurses/cpg_nursing/2010/nasogastric%20tube%20feeding%20-%20book.pdf.
[13]胡延秋,程云,王银云,等.成人经鼻胃管喂养临床实践指南的构建[J].中华护理杂志,2016,51(2):133-141.
[14]李宇轩.食道畸形患者留置胃管困难的原因分析[J].中华护理杂志,2010,45(2):3.
[15]Boeykens K,Steeman E,Duysburgh I.Reliability of p H measurement and the auscultatory method to confirm the position of a nasogastric tube[J].Int J Nurs Stud,2014,51(11):1427-1433.
[16]Turgay AS,Khorshid L.Effectiveness of the auscultatory and p Hmethods in predicting feeding tube placement[J].J Clin Nurs,2010,19(11/12):1553-1559.
[17]Nejo T,Oya S,Tsukasa T,et al.Limitations of routine verification of nasogastric tube insertion using X ray and auscultation:two case reports of life-threatening complications[J]Nutr Clin Pract,2016,31(6):780-784.
[18]刘塞玲.1例胃管误入气管的原因分析[J].中国社区医师,2017,33(13):157.
[19]Tho PC,Mordiffi S,Ang E,et al.Implementation of the evidence review on best practice for confirming the correct placement of nasogastric tube in patients in an acute care hospital[J].Int J Evid Based Healthc,2011,9(1):51-60.
[20]卢红芳,吕秋丽,卢晓云.胃管误置人气管一例报告并文献复习[J].临床误诊误治,2008,21(2):84-85.
[21]石英,唐姗姗,展淑敏.2例无典型症状留置胃管误入气管的原因分析与对策[J].护理学报,2012,19(8A):65-66.
[22]Hanna G,Phillips LD,Priest O,et al.Improving the safety of nasogastric feeding tube insertion:developing guidelines for the safe verification of feeding tube position-a decision analysis approach[J].Acta Neurochirurgica,2010,153(3):589-596.
[23]Ni MZ,Huddy JR,Priest OH,et al.Selecting p H cut-offs for the safe verification of nasogastric feeding tube placement:a decision analytical modelling approach[J].BMJ Open,2017,7(11):e18128.
[24]Fernandez RS,Chau JP,Thompson DR,et al.Accuracy of biochemical markers for predicting nasogastric tube placement in adults:a systematic review of diagnostic studies[J].Int J Nurs Stud,2010,47(8):1037-1046.
[25]唐丽,张琳,吴惠萍.测量抽吸物p H法定位鼻胃管位置的系统评价[J].中国实用护理杂志,2012,28(31):57-59.
[26]王银云,程云,胡延秋,等.呼气末二氧化碳浓度测定法判断鼻胃管位置的系统评价[J].中华护理杂志,2016,51(3):267-274.
[27]Suzanne M,Carpenter R,Blevins C,et al.Detection of inadvertent airway intubation during gastric tube insertion:capnography versus a colorimetric carbon dioxide detector[J].Am J Crit Care,2006,15(2):188-195.
[28]Erzincanli S,Zaybak A,Guler A.Investigation of the efficacy of colorimetric capnometry method used to verify the correct placement of the nasogastric tube[J].Intensive Crit Care Nurs,2017,38:46-52.
[29]Bennetzen LV,Hakonsen SJ,Svenningsen H,et al.Diagnostic accuracy of methods used to verify nasogastric tube position in mechanically ventilated adult patients:a systematic review[J].JBI Database System Rev Implement Rep,2015,13(1):188-223.
[30]Mordiffi SZ,Goh ML,Phua J,et al.Confirming nasogastric tube placement:is the colorimeter as sensitive and specific as X-ray?A diagnostic accuracy study[J].Int J Nurs Stud,2016,61:248-257.
[31]Miller SL.Capnometry vs p H testing in nasogastric tube placement[J].Gastrointestinal Nursing,2013,9(2):30-33.
[32]Swiech K,Lancaster DR,Sheehan R.Use of a pressure gauge to differentiate gastric from pulmonary placement of nasoenteral feeding tubes[J].Appl Nurs Res,1994,7(4):183-189.
[33]Chau JP,Thompson DR,Fernandez R,et al.Methods for determining the correct nasogastric tube placement after insertion:a meta-analysis[J].JBI Libr Syst Rev,2009,7(16):679-760.
[34]George J.Re:avoiding never events:improving nasogastric intubation practice and standards[J].Clin Radiol,2013,68(3):239-244.
[35]Lo JO,Wu V,Reh D,et al.Diagnosis and management of a misplaced nasogastric tube into the pulmonary pleura[J].Arch Otolaryngol Head Neck Surg,2008,134(5):547-550.
[36]孙建华,刘大为,王小亭,等.超声技术在重症护理领域中的应用进展[J].中华护理杂志,2016,51(6):729-732.
[37]Zatelli M,Vezzali N.4-Point ultrasonography to confirm the correct position of the nasogastric tube in 114 critically ill patients[J].J Ultrasound,2017,20(1):53-58.
[38]Tsujimoto H,Tsujimoto Y,Nakata Y,et al.Ultrasonography for confirmation of gastric tube placement[J].Cochrane Database Syst Rev,2017(4):D12083.
[39]Lin T,Gifford W,Lan Y,et al.Diagnostic accuracy of ultrasonography for detecting nasogastric tube(NGT)placement in adults:a systematic review and meta analysis[J].Int J Nurs Stud,2017,71:80-88.
[2]Willcox J.Nasogastric tube insertion[J].Foundation Years,2009,5(37):13-15.
[3]邵鹏,陈敏.肠内营养支持的研究进展[J].中华现代护理杂志,2012,18(13):1605-1607.
[4]葛津津,刘薇群,汤培凤,等.鼻胃管位置判断研究进展[J].解放军护理杂志,2015,32(19):37-39.
[5]Xu Z,Li W.Reminder of important clinical lesson:aspiration pneumonia caused by inadvertent insertion of gastric tube in an obtunded patient postoperatively[J].BMJ Case Rep,2011,2011(Nov 08 1):1-3.
[6]Hensel M,Marnitz R.Pneumothorax following nasogastric feeding tube insertion:case report and review of the literature[J].Anaesthesist,2010,59(3):229-234.
[7]Sellers CK.False-positive p H aspirates after nasogastric tube insertion in head and neck tumour[J].BMJ Case Rep,2012,2012(Aug 27 1):1-3.
[8]National Patient Safety Agency.Reducing the harm caused by misplaced nasogastric feeding tubes in adults,children and infants[EB/OL].(2011-03-10)[2017-12-01].http://www.nrls.npsa.nhs.uk/resources/?entryid45=129640&p=4.2011.
[9]National Nurses Nutrition Group.Safe insertion and ongoing care of nasogastric(NG)feeding tube in adults[EB/OL].(2016-04-01)[2017-12-01].http://www.nnng.org.uk/wp-content/uploads/2016/06/NNNG-Nasogastric-tube-Insertion-and-Ongoing-Care-Practice-Final-Aprill-2016.pdf.
[10]American Association of Critical-Care Nurses.Initial and ongoing verification of feeding tube placement in adults[J].Crit Care Nurse,2016,36(2):e8-e13.
[11]Bankhead R,Boullata J,Brantley S,et al.Enteral nutrition practice recommendations[J].J Parenter Enteral Nutr,2009,33(2):122-167.
[12]Ministry of Health.Nursing man agement of nasogastric tube feeding in adult patients[EB/OL].(2010-07-01)[2017-12-01]https://www.moh.gov.sg/content/dam/moh_web/HPP/Nurses/cpg_nursing/2010/nasogastric%20tube%20feeding%20-%20book.pdf.
[13]胡延秋,程云,王银云,等.成人经鼻胃管喂养临床实践指南的构建[J].中华护理杂志,2016,51(2):133-141.
[14]李宇轩.食道畸形患者留置胃管困难的原因分析[J].中华护理杂志,2010,45(2):3.
[15]Boeykens K,Steeman E,Duysburgh I.Reliability of p H measurement and the auscultatory method to confirm the position of a nasogastric tube[J].Int J Nurs Stud,2014,51(11):1427-1433.
[16]Turgay AS,Khorshid L.Effectiveness of the auscultatory and p Hmethods in predicting feeding tube placement[J].J Clin Nurs,2010,19(11/12):1553-1559.
[17]Nejo T,Oya S,Tsukasa T,et al.Limitations of routine verification of nasogastric tube insertion using X ray and auscultation:two case reports of life-threatening complications[J]Nutr Clin Pract,2016,31(6):780-784.
[18]刘塞玲.1例胃管误入气管的原因分析[J].中国社区医师,2017,33(13):157.
[19]Tho PC,Mordiffi S,Ang E,et al.Implementation of the evidence review on best practice for confirming the correct placement of nasogastric tube in patients in an acute care hospital[J].Int J Evid Based Healthc,2011,9(1):51-60.
[20]卢红芳,吕秋丽,卢晓云.胃管误置人气管一例报告并文献复习[J].临床误诊误治,2008,21(2):84-85.
[21]石英,唐姗姗,展淑敏.2例无典型症状留置胃管误入气管的原因分析与对策[J].护理学报,2012,19(8A):65-66.
[22]Hanna G,Phillips LD,Priest O,et al.Improving the safety of nasogastric feeding tube insertion:developing guidelines for the safe verification of feeding tube position-a decision analysis approach[J].Acta Neurochirurgica,2010,153(3):589-596.
[23]Ni MZ,Huddy JR,Priest OH,et al.Selecting p H cut-offs for the safe verification of nasogastric feeding tube placement:a decision analytical modelling approach[J].BMJ Open,2017,7(11):e18128.
[24]Fernandez RS,Chau JP,Thompson DR,et al.Accuracy of biochemical markers for predicting nasogastric tube placement in adults:a systematic review of diagnostic studies[J].Int J Nurs Stud,2010,47(8):1037-1046.
[25]唐丽,张琳,吴惠萍.测量抽吸物p H法定位鼻胃管位置的系统评价[J].中国实用护理杂志,2012,28(31):57-59.
[26]王银云,程云,胡延秋,等.呼气末二氧化碳浓度测定法判断鼻胃管位置的系统评价[J].中华护理杂志,2016,51(3):267-274.
[27]Suzanne M,Carpenter R,Blevins C,et al.Detection of inadvertent airway intubation during gastric tube insertion:capnography versus a colorimetric carbon dioxide detector[J].Am J Crit Care,2006,15(2):188-195.
[28]Erzincanli S,Zaybak A,Guler A.Investigation of the efficacy of colorimetric capnometry method used to verify the correct placement of the nasogastric tube[J].Intensive Crit Care Nurs,2017,38:46-52.
[29]Bennetzen LV,Hakonsen SJ,Svenningsen H,et al.Diagnostic accuracy of methods used to verify nasogastric tube position in mechanically ventilated adult patients:a systematic review[J].JBI Database System Rev Implement Rep,2015,13(1):188-223.
[30]Mordiffi SZ,Goh ML,Phua J,et al.Confirming nasogastric tube placement:is the colorimeter as sensitive and specific as X-ray?A diagnostic accuracy study[J].Int J Nurs Stud,2016,61:248-257.
[31]Miller SL.Capnometry vs p H testing in nasogastric tube placement[J].Gastrointestinal Nursing,2013,9(2):30-33.
[32]Swiech K,Lancaster DR,Sheehan R.Use of a pressure gauge to differentiate gastric from pulmonary placement of nasoenteral feeding tubes[J].Appl Nurs Res,1994,7(4):183-189.
[33]Chau JP,Thompson DR,Fernandez R,et al.Methods for determining the correct nasogastric tube placement after insertion:a meta-analysis[J].JBI Libr Syst Rev,2009,7(16):679-760.
[34]George J.Re:avoiding never events:improving nasogastric intubation practice and standards[J].Clin Radiol,2013,68(3):239-244.
[35]Lo JO,Wu V,Reh D,et al.Diagnosis and management of a misplaced nasogastric tube into the pulmonary pleura[J].Arch Otolaryngol Head Neck Surg,2008,134(5):547-550.
[36]孙建华,刘大为,王小亭,等.超声技术在重症护理领域中的应用进展[J].中华护理杂志,2016,51(6):729-732.
[37]Zatelli M,Vezzali N.4-Point ultrasonography to confirm the correct position of the nasogastric tube in 114 critically ill patients[J].J Ultrasound,2017,20(1):53-58.
[38]Tsujimoto H,Tsujimoto Y,Nakata Y,et al.Ultrasonography for confirmation of gastric tube placement[J].Cochrane Database Syst Rev,2017(4):D12083.
[39]Lin T,Gifford W,Lan Y,et al.Diagnostic accuracy of ultrasonography for detecting nasogastric tube(NGT)placement in adults:a systematic review and meta analysis[J].Int J Nurs Stud,2017,71:80-88.