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中华医学超声杂志(电子版) ›› 2018, Vol. 15 ›› Issue (06) : 464 -468. doi: 10.3877/cma.j.issn.1672-6448.2018.06.014

所属专题: 文献

重症超声影像学

简化床旁超声法在重症患者鼻肠管定位中的应用价值
张细江1,(), 司琴1, 郑诚1, 李波2, 王昌明1   
  1. 1. 318000 浙江台州,台州学院医学院附属市立医院重症医学科
    2. 318000 浙江台州,台州学院医学院附属市立医院超声科
  • 收稿日期:2017-09-02 出版日期:2018-06-01
  • 通信作者: 张细江

Simplified bedside ultrasound method in confirming the correct location of nasointestinal tube in critically ill patients

Xijiang Zhang1,(), Qin Si1, Cheng Zheng1, Bo Li2, Changmin Wang1   

  1. 1. Intensive Care Unit, Taizhou Municipal Hospital Affiliated to Taizhou University, Taizhou 318000, China
    2. Depatment of Ultrasonorgaphy, Taizhou Municipal Hospital Affiliated to Taizhou University, Taizhou 318000, China
  • Received:2017-09-02 Published:2018-06-01
  • Corresponding author: Xijiang Zhang
  • About author:
    Corresponding author: Zhang Xijiang, Emai:
引用本文:

张细江, 司琴, 郑诚, 李波, 王昌明. 简化床旁超声法在重症患者鼻肠管定位中的应用价值[J/OL]. 中华医学超声杂志(电子版), 2018, 15(06): 464-468.

Xijiang Zhang, Qin Si, Cheng Zheng, Bo Li, Changmin Wang. Simplified bedside ultrasound method in confirming the correct location of nasointestinal tube in critically ill patients[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2018, 15(06): 464-468.

目的

探讨简化床旁超声法在重症患者鼻肠管定位的应用价值。

方法

选择2016年3月至2017年4月台州市立医院重症医学科收治的需留置鼻肠管的患者59例。应用简化床旁超声法定位鼻肠管。超声探及幽门管处鼻肠管声影,且鼻肠管插入长度符合鼻尖至空肠的预计距离,则认为鼻肠管进入空肠。鼻肠管放置结束后,立即进行床旁超声检查及床旁腹部X线检查。以腹部X线检查结果作为验证鼻肠管头端位置的"金标准",计算简化床旁超声法鼻肠管定位的敏感度、特异度、准确性、阳性预测值、阴性预测值。采用Kappa分析分析简化床旁超声法与腹部X线检查对重症患者鼻肠管定位的一致性。

结果

简化床旁超声法判定鼻肠管进入空肠50例,腹部X线检查验证49例空肠在位;简化床旁超声法判定鼻肠管未进入空肠9例,腹部X线检查验证4例空肠在位。以腹部X线检查结果作为验证鼻肠管头端位置的"金标准",简化床旁超声法鼻肠管定位的敏感度、特异度、准确性、阳性预测值、阴性预测值分别为92.45%、83.33%、89.83%、98.00%、44.44%。Kappa分析结果显示,简化床旁超声法与腹部X线检查对重症患者鼻肠管定位的一致性Kappa=0.620。

结论

简化床旁超声法可以定位鼻肠管,其准确程度高,简单易学,快速方便,具有较好的临床应用价值。

Objective

To evaluate the practicability of simplified bedside ultrasound method in confirming the correct placement of nasointestinal tube in critically ill patients.

Methods

Totally 59 critically ill patients who had nasointestinal tube indwelled were collected from March, 2016 to April, 2017 in Intensive Care Unit of Taizhou municipal Hospital. In these patients, the location of nasointestinal tubes were detected by using simplified bedside ultrasound method. The nasointestinal tube was confirmed in jejunum if acoustic shadow of nasointestinal tube was detected in canales pyloricus and the insertion length of the nasointestinal tube conformed to the estimated distance from the tip of the nose to the jejunum. Radiographic testing was applied as golden standard for judging naso-jejunal location. Then the accuracy, sensitivity, specificity and consistency with radiographic testing were calculated.

Results

Simplified bedsode ultrasound method showed that 50 patients had tubes in position, and 49 of them were confirmed in position by radiographic testing. This method showed that 9 patients did not have tubes in position, while 4 of them were confirmed in position by radiographic testing. Thus, the accuracy, sensitivity and specificity of simplified bedside ultrasound method in judging positions of nasointestinal tubes was 89.83% (53/59), 92.45% (49/53), and 83.33% (5/6). The results of analysis showed that simplified bedside ultrasound and abdominal X-ray examination showed a general consistency in nasointestinal tube localization in severe patients (Kappa=0.620, P<0.001).

Conclusions

Simplified bedside ultrasound method can confirm naso-jejunal tube position in critically ill patients. This method is accurate, easy to learn,and can be detected quickly and conveniently. Simplified bedside ultrasound method has favorable clinical application value.

图1~3 幽门管超声声像图。图1为幽门管横切面,"纽扣样"管状声像;图2为幽门管纵切面,"腊肠样"声像,内见呈"双轨征"的鼻肠管;图3为幽门管纵切面,内见充气后呈条状强回声的鼻肠管
表1 简化床旁超声法在重症患者鼻肠管定位的应用价值(例)
1
王洪亮, 章志丹, 黄伟. 拯救脓毒症运动:脓毒症和感染性休克治疗国际指南(2016)的解读和展望 [J/OL]. 中华重症医学电子杂志, 2017, 3(1): 26-32.
2
Taylor BE, McClave SA, Martindale RG, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) [J]. Crit Care Med, 2016, 44(2): 390-438.
3
Kalil AC, Metersky ML, Klompas M, et al. Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society [J]. Clin Infect Dis, 2016, 63(5): e61-e111.
4
Doig GS, Heighes PT, Simpson F, et al. Early enteral nutrition reduces mortality in trauma patients requiring intensive care: a meta-analysis of randomised controlled trials [J]. Injury, 2011, 42(1): 50-56.
5
Heyland DK, Stephens KE, Day AG, et al. The success of enteral nutrition and ICU-acquired infections: a multicenter observational study [J]. Clin Nutr, 2011, 30(2): 148-155.
6
Huang HH, Hsu CW, Kang SP, et al. Association between illness severity and timing of initial enteral feeding in critically ill patients: a retrospective observational study [J]. Nutr J, 2012, 11: 30.
7
中华医学会重症医学分会. 中国重症加强治疗病房危重患者营养支持指导意见 [J]. 中华外科杂志, 2006, 44(17): 1167-1177.
8
Prabhakaran S, Doraiswamy VA, Nagaraja V, et al. Nasoenteric tube complications [J]. Scand J Surg, 2012, 101(3): 147-155.
9
Metheny NA, Meert KL. Monitoring feeding tube placement [J]. Nutr Clin Pract, 2004, 19(5): 487-495.
10
Taylor SJ, Clemente R. Confirmation of nasogastfic tube position by pH testing [J]. J Hum Nutr Diet, 2005, 18(5): 371-375.
11
王莹, 王勇强, 焦亚男, 等. 注气法置胃肠双腔管在腹腔高压机械通气患者中的应用 [J]. 中华急诊医学杂志, 2014, 23(6): 663-666.
12
封秀琴, 金静芬, 黄晓霞, 等. 超声定位改良胃内注气法留置鼻肠管在创伤患者中的应用 [J]. 中华急诊医学杂志, 2014, 23(10): 1169-1171.
13
Cubillos J, Tse C, Chan VW, et al. Bedside ultrasound assessment of gastric content: an observational study [J]. Can J Anaesth, 2012, 59(4): 416-423.
14
陈培服, 唐时元, 曹珏. 采用超声引导下导丝位移法对胃排空障碍危重患者置入三腔喂养管的经验分享 [J]. 华西医学, 2016, 31(6): 1023-1027.
15
李刚, 柯路, 潘伊媛, 等. 床边B超判断重症急性胰腺炎病人鼻肠管位置的应用评价 [J]. 肠外与肠内营养, 2016, 23(3): 182-184.
16
张美齐, 陈环, 张可, 等. 采用床旁超声波对重症患者鼻肠管快速定位方法的观察 [J]. 中华医学杂志, 2016, 96(29): 2307-2310.
17
伏钢, 吴曙军, 杨斌, 等. 超声造影引导鼻空肠管置放术 [J]. 中华超声影像学杂志, 2009, 18(11): 953-955.
18
叶瑞忠, 范小明, 王立刚, 等. 改良超声方法在重症患者留置鼻肠管头端定位中的初步应用 [J]. 中华临床营养杂志, 2016, 24(4): 199-202.
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