呼吸重症患者行肠内营养致全段食管梗阻原因分析及预防措施OA

Objective To analyze the causes of total esophageal obstruction in patients with respiratory critical illness receiving enteral nutrition,and to explore the management strategies.Methods A retrospective analysis was conducted on the causes,clinical manifestations,management,and prognosis of total esophageal obstruction induced by nasogastric tube enteral nutrition in 6 patients with respiratory critical illness admitted to the department of respiratory and critical care medicine of Second Afffliated Hospital of Anhui Medical University from January 2021 to May 2024.Results The total esophageal obstruction in 6 patients with respiratory critical illness was due to nasogastric tube enteral nutrition,all caused by dense adhesion of enteral nutrition coagulation clots to the entire esophageal wall.The etiology may be related to gastroesophageal reflux,reduced esophageal clearance capacity,prolonged mechanical ventilation,or improper placement depth of the nasogastric tube.All cases underwent bedside gastroscopy for definitive diagnosis and removal of the coagulation clots.Esophageal obstruction was resolved in 5 cases,with no recurrence after replacement with jejunal feeding tubes.Only 1 case remained unresolved.Conclusions The causes of total esophageal obstruction in respiratory critical patients receiving enteral nutrition are multifactorial,with early symptoms being insidious.Diagnosis is challenging due to the reflux of oral enteral nutrition solutions and difficulties in chest imaging,often leading to delayed confirmation.Bedside gastroscopy remains the first-line diagnostic and therapeutic approach.However,prevention is paramount.Implementing etiology-specific preventive measures can effectively reduce the incidence of total esophageal obstruction,alleviating patient suffering and economic burden.