【摘要】：目的:探討利用胃腸超聲造影技術(shù)聯(lián)合氣體灌注對(duì)危重癥病人鼻腸管進(jìn)行定位的方法。方法:隨機(jī)選擇符合鼻腸管留置指征的危重癥病人60例,采用床旁盲插法,置管過程中均常規(guī)采用傳統(tǒng)氣體灌注聽診法對(duì)鼻腸管進(jìn)行初步定位,并記錄結(jié)果。置管完成后,先通過超聲掃查鼻腸管走行利用氣體灌注法輔助定位,直至可疑頭端位置,采用氣體沖擊灌注,若該處腸腔內(nèi)出現(xiàn)瞬間氣體強(qiáng)回聲充盈,再將胃窗聲學(xué)造影劑注入鼻腸管。若腸腔內(nèi)出現(xiàn)造影劑充盈并清晰顯示鼻腸管頭端可予以明確。以胸腹部X線檢查為判斷鼻腸管定位的金標(biāo)準(zhǔn),幽門后置管為置管成功的標(biāo)準(zhǔn),將胃腸超聲造影技術(shù)聯(lián)合氣體灌注法與傳統(tǒng)氣體灌注聽診法進(jìn)行比較。比較兩種方法進(jìn)行鼻腸管定位的敏感性、特異性、陽性預(yù)測(cè)值、陰性預(yù)測(cè)值和準(zhǔn)確度。結(jié)果:在60例行胃腸超聲造影技術(shù)聯(lián)合氣體灌注法定位鼻腸管的病人中,定位成功58例(96.7%),其中56例位于幽門后,2例位于胃內(nèi),定位失敗2例(3.3%),敏感性為96.6%,特異性為100%,陽性預(yù)測(cè)值為100%,陰性預(yù)測(cè)值為50%,準(zhǔn)確度為96.7%。傳統(tǒng)氣體灌注聽診法的敏感性為74.1%,特異性為50%,陽性預(yù)測(cè)值為97.7%,陰性預(yù)測(cè)值為6.3%,準(zhǔn)確度為73.3%。經(jīng)統(tǒng)計(jì)學(xué)分析,除陽性預(yù)測(cè)值外,其余均高于傳統(tǒng)氣體灌注聽診法(P0.05)。結(jié)論:胃腸超聲造影技術(shù)聯(lián)合氣體灌注法具有較高的敏感性、特異性、陰性預(yù)測(cè)值和準(zhǔn)確度,可成為一種準(zhǔn)確、實(shí)時(shí)、便捷、安全的鼻腸管定位方法。
[Abstract]:Objective: to study the localization of nasoenteric tube in critically ill patients by gastroenterography combined with gas perfusion. Methods: 60 critically ill patients who were in accordance with the indwelling indication of nasal and intestinal tube were randomly selected. The primary localization of nasoenteric tube was performed by conventional gas perfusion auscultation during the procedure of bedside blind insertion, and the results were recorded. After the tube placement was completed, the nasoenteric tube was examined by ultrasonic scanning and the gas perfusion method was used to assist the location until the suspicious head end was located, and the gas shock perfusion was used. If there was an instant strong echo of gas in the intestinal cavity, Then the stomach window contrast agent was injected into the nasoenteric tube. If the contrast agent is filled in the lumen and clearly shows the head of the naso-intestinal tube, it can be clearly defined. The chest and abdomen X-ray examination was taken as the gold standard to judge the localization of nasoenteric tube and the pyloric posterior tube was used as the standard of successful catheterization. The gastroenterography combined with gas perfusion method was compared with the traditional gas perfusion auscultation method. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the two methods were compared. Results: of the 60 patients who underwent gastroenterography combined with gas perfusion, 58 cases (96.7%) were successfully located, of which 56 cases were located in the stomach, 2 cases were located in the posterior pyloric tract, 2 cases were located in the stomach. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 96. 6%, 100, 100, 50 and 96. 7% respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of traditional gas perfusion auscultation were 74.1, 50, 97.7, 6.3 and 73.3 respectively. By statistical analysis, except positive predictive value, the rest were higher than traditional gas perfusion auscultation (P0.05). Conclusion: Gastrointestinal ultrasonography combined with gas perfusion has high sensitivity, specificity, negative predictive value and accuracy. It can be used as an accurate, real-time, convenient and safe method for the localization of nasal and intestinal tubes.
【作者單位】： 浙江省人民醫(yī)院超聲科;浙江省人民醫(yī)院重癥醫(yī)學(xué)科;
【分類號(hào)】：R459.3

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