Effect Of Warm-hot Water Stimulation On Nasointestinal Tube Active Insertion In Critically Ill Patients

Objective1.To explore the optimal temperature range of warm water to stimulate gastrointestinal peristalsis and its feasibility.2.To explore the application effect of warm-hot water in the besid active indwelling of nasointestinal tube for critically ill patients.MethodsPart 1:Based on the results of literature review,search for the best temperature to stimulate gastrointestinal peristalsis,20 healthy volunteers were selected to take 20ml water at 41℃,43℃,45℃,47℃,49℃,52℃,55℃and 60℃respectively by the interval of 40 minutes.Monitor the motilite index by ultrasound after taking water at different temperatures.At the same time,collect the subjective feeling,oral mucosa scald,digestive system discomfort,collect the abdominal pain,diarrhea and other digestive system adverse reactions within 2 days;the first stool flora analysis results were collected within 2 days to check the occurrence of aseptic group imbalance.Part 2:138 critically ill patients with nasointestinal tube indwelling in the Department of critical care medicine of a class III a hospital in Qingdao from December 2018 to August2020 were selected as the research objects.They were divided into the observation group and the control group by random number table.In the control group,intravenous injection of metoclopramide was used to stimulate gastrointestinal peristalsis.In the observation group,during the active placement of nasointestinal tube,warm-hot water(45℃～47℃)was injected intermittently to stimulate gastrointestinal peristalsis.The antral motility index(MI)of the two groups was measured before and after intervention,and the Success rate of catheterization,the complications,the total duration of placement of tube,the time of enteral nutrition reaching the standard after placement of tube,the complications within 7 days of enteral nutrition and the results of fecal flora analysis on the seventh day were recorded between the two groups,compare the effect of warm-hot water and injection of methoxyclopramine in the besid active indwelling of nasointestinal tube.ResultsPart 11.Twenty volunteers were included in this study,the twenty volunteers were including13 males and 7 females,age(36.15±11.46),BMI 24.60±2.73Kg/m~2.the results of MI and fecal flora analysis were normal before the experiment.2.Through pairwise comparison between the average value of MI at different temperatures,the results showed that the MI increased significantly at 45℃,and the difference was statistically significant(P<0.05);The MI was no significant difference between before intervention and after intake of 41℃,43℃warm water(P>0.05);The MI was no significant difference after intake of 47℃,49℃,55℃Water(P>0.05),but compared with before intervention and intake of 41℃and 43℃warm water,MI increased significantly(P<0.05),and compared with intake of 45℃water,There was no significant difference(P>0.05).3.All volunteers were able to drink warm water at 47℃,49℃,52℃,55℃and 60℃in one gulp.The digestive system was tolerable,without burning sensation,no oral scald,no diarrhea,abdominal pain and other digestive system discomfort within 2 days,and the first stool flora analysis within 2 days was normal.In terms of subjective perception of water temperature,20 volunteers had different subjective perception of different water temperatures.Part 21.There was no significant difference in age,gender,APACHEⅡscore,height,weight,BMI,MI before indwelling nasointestinal tube,albumin,prealbumin level,state of consciousness and disease before indwelling nasointestinal tube between the two groups(P>0.05).2.There were all significant differences in antral motility index before and after intervention in the two groups(P<0.01).The MI of 45℃～47℃warm water group was better than that of metoclopramide group after intervention(P<0.01).3.The total time of catheterization in the observation group was 26(23,31.5)min,which was shorter than 29(23,35)min in the control group,there was significant difference in the total catheterization time between the two groups(P<0.01),but there was no significant difference in the success rate,complications and the time of target feeding between the two groups(P>0.05).4.There was no significant difference in the incidence of complications within 7 days after enteral nutrition,albumin and prealbumin on the 7th day,and flora imbalance within7 days between the two groups(P>0.05).ConclusionsIn the process of active indwelling of nasointestinal tube beside the bed in critically ill patients,intermittent injection of warm water at 45℃～47℃can stimulate gastrointestinal peristalsis,and the effect is better than that of metoclopramide,which is superior to metoclopramide,and has the same effect as metoclopramide in the success rate of catheterization.This method works in real time and does not need to wait for the drug to take effect.The temperature range is safe for the digestive system and will not lead to the occurrence of related complications such as flora imbalance.And the method is simple to operate and not technically difficult,so it is worth popularizing in clinic.