胃肠超声造影技术联合气体灌注定位鼻肠管的方法学研究

发布时间：2018-07-14 22:07

【摘要】：目的:探讨利用胃肠超声造影技术联合气体灌注对危重症病人鼻肠管进行定位的方法。方法:随机选择符合鼻肠管留置指征的危重症病人60例,采用床旁盲插法,置管过程中均常规采用传统气体灌注听诊法对鼻肠管进行初步定位,并记录结果。置管完成后,先通过超声扫查鼻肠管走行利用气体灌注法辅助定位,直至可疑头端位置,采用气体冲击灌注,若该处肠腔内出现瞬间气体强回声充盈,再将胃窗声学造影剂注入鼻肠管。若肠腔内出现造影剂充盈并清晰显示鼻肠管头端可予以明确。以胸腹部X线检查为判断鼻肠管定位的金标准,幽门后置管为置管成功的标准,将胃肠超声造影技术联合气体灌注法与传统气体灌注听诊法进行比较。比较两种方法进行鼻肠管定位的敏感性、特异性、阳性预测值、阴性预测值和准确度。结果:在60例行胃肠超声造影技术联合气体灌注法定位鼻肠管的病人中,定位成功58例(96.7%),其中56例位于幽门后,2例位于胃内,定位失败2例(3.3%),敏感性为96.6%,特异性为100%,阳性预测值为100%,阴性预测值为50%,准确度为96.7%。传统气体灌注听诊法的敏感性为74.1%,特异性为50%,阳性预测值为97.7%,阴性预测值为6.3%,准确度为73.3%。经统计学分析,除阳性预测值外,其余均高于传统气体灌注听诊法(P0.05)。结论:胃肠超声造影技术联合气体灌注法具有较高的敏感性、特异性、阴性预测值和准确度,可成为一种准确、实时、便捷、安全的鼻肠管定位方法。
[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.
【作者单位】：浙江省人民医院超声科;浙江省人民医院重症医学科;
【分类号】：R459.3

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