【作者】 张美齐； 陈环； 张可； 沈晔； 李刚； 韩楠楠； 李声琴； 许秋然； Linxiao Pang；

【Author】 Zhang Meiqi;Huan Chen;Ke Zhang;Ye Shen;Gang Li;Nannan Han;Linxiao Pang;Shengqing Li;Xu Qiuran;Department of Emergency,Zhejiang Provincial People’s Hospital;

【机构】 浙江省人民医院； Department of Emergency,Zhejiang Provincial People’s Hospital；

【摘要】 目的:探讨床旁超声快速定位EICU重症患者鼻肠管位置的新方法,为判断盲插鼻肠管是否成功提供更加简便快捷的途径。方法:收集2015年6月~2016年2月间于浙江省人民医院EICU符合指征的70名重症患者,以床旁盲插法置入鼻肠管,应用床旁B超定位,于腹主动脉、下腔静脉及肠系膜上动脉、上静脉之间(B超可见"血管征")探查鼻肠管,并与常规定位法(听诊法、抽吸液观察法)比较,以X线及CT为金标准,评价床旁B超定位新方法的效能。应用SPSS13.0统计软件计算常规法(听诊法和抽吸观察法)、床旁超声"血管征"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。将床旁超声"血管征"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(四格表卡方检验),以P<0.05为差异有统计学意义。结果:1)70例重症患者经CT确认鼻肠管胃内异位4例(异位率5.3%)。2)听诊法和抽吸液观察法的敏感性分别为78.6%、72.7%,特异性分别为25.0%、75.0%,阳性预测值分别为94.5%、97.9%,阴性预测值分别为6.6%、14.2%,准确率分别为75.2%、72.0%。3)床旁B超"血管征"法的敏感性100%,特异性100%,阳性预测值和阴性预测值均为100%,准确率达100%,除阳性预测值外,其余明显高于常规听诊法及抽吸液观察法,差异具有统计学意义(P<0.05)。结论:应用床旁B超"血管征"法确定EICU重症患者的鼻肠管管位置较传统定位法具有更高的敏感性、特异性、阴性预测值及准确性,而且床旁B超"血管征"法简单、快速、无辐射,值得进一步研究和推广。更多还原

【Abstract】 Objective To evaluate the feasibility of bedside ultrasound in confirming correct nasointestinal tube placement of critical patients in EICU.Methods The total admitted critical patients was 70 cases with 37 males and 33 females.Using bedside ultrasound(vessels signe) to confirm the location of nasointestinal tube at different site of digestive tract,comparing with the traditional methods(auscultatory method and aspirates from tube method).And then the value of ultrasound was assessed with chi-square statistics.Results Auscultatory method and aspirates from tube method have lower sensitivity(78.6%,72.7%) and specificity(25.0%,75.0%).bedside ultrasound(vessels signe) method sensitivity(100%),accuracy(100%),positive predictive value(100%),negative predictive value(100%)and precision ratio are all higher than auscultatory method and aspirates from tube method,the difference was statistically significant(P < 0.05).Conclusion Compared with the traditional methods,the bedside ultrasound(vessels signe) method has more advantages in confirming the location of the tubes at different site of enteral route.更多还原