Research On Risk Factors Associated With Gastroesophageal Reflux In Elderly Patients With Long-term Nasal Feeding And Nursing Countermeasure

Objective:To investigate the accuracy and feasibility of Brix value on the monitoring of gastric residual volume(GRV)in patients,then to analyze the correlation between GRV and gastro esophageal reflux(GER),and the related risk factors of GER in elderly nasogastric patients.Then the comparison of different supine position(head up to 30-45 °or 60-90 °)and different feeding method(using pump or feeding syringe)on elderly nasogastric patients with GER,in order to effectively reduce the occurrence of GER or relieve the related symptoms in this population.Methods:1.Comparing ultrasound and Brix value to measure GRV,verifying the feasibility,accuracy and advantages and disadvantages of the Brix value for measuring GRV2.GRV were calculate with Brix value,and pepsin was used as an index for screening GER,then analyzing the correlation between GER and GRV,and the risk factors associated with GER in elderly patients with long-term nasal feeding.3.The content of pepsin in saliva was measured in the morning and after meals,factorial design was used to analyze the dose-effect relationship between supine position and nasal feeding method.Results:1.Paired-sample t-test showed no significant difference in GRV by ultrasound and Brix value(P>0.05),and Pearson correlation analysis showed a positive correlation(r=0.986,P<0.05).The consistency of the two measurements was analyzed by Bland-Altman graph,showing that the two measurements had consistency.2.There was no correlation between GRV and GER(P>0.05).Multivariate analysis showed that aged>diabetes and nasal feeding method were risk factors for GER,with OR values of 5.449,5.449,3.812,respectively.3.The Wilcoxon Signed Rank Test showed that there was no statistically significant differencein pepsin content between morning and post-prandial(Z=-1.355,P=0.175)The Pearson pairing correlation coefficient indicating a positive correlation between the two measurements(r=0.439,P<0.05).4.The factorial test results showed that there was no interaction between the feeding position and the methods.Feeding position had no effect on pepsin concentration(P>0.05).Feeding method had an effect on pepsin concentration(P<0.05).Conclusion:1.Brix value to estimate the GRV is convenient,feasible and accurate.It is of great significance to further study of the relationship between GRV and enteral nutritional complications and reflux.2.Age,diabetes,and nasal feeding method are risk factors for GER.3.There was no statistical difference in morning and postprandial pepsin content.In different populations,the normal range of pepsin content was different.When screening or diagnosing GER according to pepsin content,the actual situation of the patient should be considered.4.For elderly patients with nasogastric feeding and long-term bed rest,it is advisable to raise the head of the bed by 30-45°,and it is best to use nasal pumps for nasal feeding.