床旁超声快速确定严重创伤患者鼻饲管位置的初步研究
发布时间：2018-07-17 18:29
【摘要】：目的： 评估应用床旁超声协助确定严重创伤患者鼻饲管位置的价值,为鼻饲管的定位提供一种快速有效的新方法。 方法： 为前瞻性对照观察研究。研究对象为2011年10月至2012年3月一家大学附属的三级甲等综合性医院急诊ICU内符合指征的115例严重创伤患者,以床旁盲插法置入鼻饲管,应用床旁超声在不同部位(颈部、食道下端-贲门、胃体)探查鼻饲管进行定位,并与常规定位法(听诊法、抽吸液观察法)比较,以X线摄片为金标准,评价不同定位方法的效能。应用SPSS13.0统计软件包(SPSS公司,美国),计算常规法(听诊法和抽吸观察法)、床旁颈部超声定位法、腹部超声(包括食道-贲门定位法和胃体定位法)行鼻饲管定位的敏感性、特异性、阳性预测值、阴性预测值和准确度,结果以计数或率表示。将不同超声定位方法和常规听诊法、抽吸观察法进行敏感性、特异性、阳性预测值、阴性预测值和准确度的比较,对超声三种检查方法敏感性、特异性、阳性预测值、阴性预测值和准确度进行比较(四格表卡方检验),以P0.05为差异有统计学意义。 结果： 1)115例患者经X线摄片确认鼻饲管异位7例(异位率6%),其中气管内异位3例、食道内返折4例。 2)听诊法和抽吸液观察法的敏感性(分别为79.6%,73.1%)、特异性(28.6%,71.4%)均较低,准确率为76.5%、73.0%。 3)超声颈部定位法的敏感性(100%)和准确性(96.5%)最高,阴性预测值达100%,但特异性(42.9%)低。 4)超声食道-贲门定位法的敏感性(88.9%)和准确率(89.6%)较高,但阴性预测值为36.8%低于超声颈部定位法,特异性达100%。 5)超声颈部联合食道-贲门内鼻饲管定位法敏感性88.9%,特异性42.9%,阳性预测值和阴性预测值均为100%,准确率达86.1%。 结论： 应用床旁超声确定严重创伤患者的鼻饲管位置较传统定位法具有更高的敏感性和准确性,其中颈部联合食道-贲门超声定位可进一步提高特异性；而且超声定位法简单、快速、无辐射,值得进一步研究和推广
[Abstract]:Objective: to evaluate the value of bedside ultrasound in determining the location of nasogastric feeding tube in patients with severe trauma, and to provide a new rapid and effective method for the location of nasogastric tube. Methods: a prospective controlled study was conducted. From October 2011 to March 2012, 115 patients with severe trauma in emergency ICU of Grade 3A General Hospital affiliated to a university were placed in nasogastric tube with bedside blind insertion, and bedside ultrasound was used in different areas (neck, neck and neck). The lower end of esophagus-cardia and body of stomach) were used to locate the nasal feeding tube, and compared with the conventional localization method (auscultation, aspiration observation), the effectiveness of different localization methods was evaluated by using X-ray film as the gold standard. SPSS 13.0 statistical software package (SPSS, USA) was used to calculate the sensitivity of nasogastric tube localization by routine methods (auscultation and aspiration observation), bedside cervical ultrasound localization, abdominal ultrasound (including esophagal-cardia localization and gastric body localization). Specificity, positive predictive value, negative predictive value, and accuracy, the result is expressed as a count or rate. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of different ultrasonic localization methods and routine auscultation methods were compared, and the sensitivity, specificity and positive predictive value of three ultrasonic examination methods were compared. Negative predictive value and accuracy were compared (four square test), with P0.05 as the difference was statistically significant. Results: 1) among 115 patients, 7 cases (6%) were diagnosed as ectopic by nasogastric tube, among which 3 cases were ectopic in trachea, 3 cases were ectopic in trachea, and 3 cases were ectopic in trachea. The sensitivity and specificity of auscultation and aspiration fluid observation were 79.631% and 71.4%, respectively. The accuracy rate was 76.575% and 73.0%, respectively. The sensitivity (100%) and accuracy (96.5%) of ultrasonic cervical localization were the highest. The negative predictive value was 100, but the specificity (42.9%) was low. 4) the sensitivity (88.9%) and accuracy (89.6%) of ultrasound esophagal-cardiac localization were higher, but the negative predictive value of 36.8% was lower than that of cervical localization. The specificity was 100. 5) the sensitivity of ultrasonography combined with esophagal-cardiac nasogastric tube localization was 88.9 and the specificity was 42.9. The positive predictive value and negative predictive value were 100 and the accuracy was 86.1%. Conclusion: bedside ultrasound is more sensitive and accurate in determining the position of nasogastric tube in patients with severe trauma than the traditional localization method. Moreover, ultrasonic localization method is simple, rapid and radiation-free, which is worthy of further study and popularization.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R641
本文编号：2130551
[Abstract]:Objective: to evaluate the value of bedside ultrasound in determining the location of nasogastric feeding tube in patients with severe trauma, and to provide a new rapid and effective method for the location of nasogastric tube. Methods: a prospective controlled study was conducted. From October 2011 to March 2012, 115 patients with severe trauma in emergency ICU of Grade 3A General Hospital affiliated to a university were placed in nasogastric tube with bedside blind insertion, and bedside ultrasound was used in different areas (neck, neck and neck). The lower end of esophagus-cardia and body of stomach) were used to locate the nasal feeding tube, and compared with the conventional localization method (auscultation, aspiration observation), the effectiveness of different localization methods was evaluated by using X-ray film as the gold standard. SPSS 13.0 statistical software package (SPSS, USA) was used to calculate the sensitivity of nasogastric tube localization by routine methods (auscultation and aspiration observation), bedside cervical ultrasound localization, abdominal ultrasound (including esophagal-cardia localization and gastric body localization). Specificity, positive predictive value, negative predictive value, and accuracy, the result is expressed as a count or rate. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of different ultrasonic localization methods and routine auscultation methods were compared, and the sensitivity, specificity and positive predictive value of three ultrasonic examination methods were compared. Negative predictive value and accuracy were compared (four square test), with P0.05 as the difference was statistically significant. Results: 1) among 115 patients, 7 cases (6%) were diagnosed as ectopic by nasogastric tube, among which 3 cases were ectopic in trachea, 3 cases were ectopic in trachea, and 3 cases were ectopic in trachea. The sensitivity and specificity of auscultation and aspiration fluid observation were 79.631% and 71.4%, respectively. The accuracy rate was 76.575% and 73.0%, respectively. The sensitivity (100%) and accuracy (96.5%) of ultrasonic cervical localization were the highest. The negative predictive value was 100, but the specificity (42.9%) was low. 4) the sensitivity (88.9%) and accuracy (89.6%) of ultrasound esophagal-cardiac localization were higher, but the negative predictive value of 36.8% was lower than that of cervical localization. The specificity was 100. 5) the sensitivity of ultrasonography combined with esophagal-cardiac nasogastric tube localization was 88.9 and the specificity was 42.9. The positive predictive value and negative predictive value were 100 and the accuracy was 86.1%. Conclusion: bedside ultrasound is more sensitive and accurate in determining the position of nasogastric tube in patients with severe trauma than the traditional localization method. Moreover, ultrasonic localization method is simple, rapid and radiation-free, which is worthy of further study and popularization.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R641
【参考文献】
相关期刊论文 前1条
1 杨宇龙;王农荣;付小君;周晓英;;B超引导下螺旋型鼻肠管置入的可行性研究[J];江西医药;2011年06期
，本文编号：2130551
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