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中华老年病研究电子杂志

中华老年病研究电子杂志 ›› 2022, Vol. 09 ›› Issue (02) : 27 -30. doi: 10.3877/cma.j.issn.2095-8757.2022.02.006

老年重症疾病

超声定位联合渐进式注水法在老年重症患者鼻肠管置管中的应用
任秋艳1, 宋佳1,†(), 龚仕金1, 胡伟航1, 王敏佳1, 高翔2   
  1. 1. 310013　杭州，浙江医院重症医学科
    2. 312500　绍兴市新昌县人民医院重症医学科
  • 收稿日期:2021-10-13 出版日期:2022-05-28
  • 通信作者: 宋佳
  • 基金资助:
    浙江省医药卫生重大科技计划项目(WKJ-ZJ-1601); 浙江省医药卫生科研基金项目(2021KY007)

Application of ultrasound localization combined with water injection in nasointestinal tube placement in elderly patients with severe diseases

Qiuyan Ren1, Jia Song1,†(), Shijin Gong1, Weihang Hu1, Minjia Wang1, Xiang Gao2   

  1. 1. Department of Critial Care Medicine, Zhejiang Hospital, Hangzhou 310013, China
    2. Department of Critial Care Medicine, Xinchang People’s Hospital, Xinchang 312500, China
  • Received:2021-10-13 Published:2022-05-28
  • Corresponding author: Jia Song
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任秋艳, 宋佳, 龚仕金, 胡伟航, 王敏佳, 高翔. 超声定位联合渐进式注水法在老年重症患者鼻肠管置管中的应用[J]. 中华老年病研究电子杂志, 2022, 09(02): 27-30.

Qiuyan Ren, Jia Song, Shijin Gong, Weihang Hu, Minjia Wang, Xiang Gao. Application of ultrasound localization combined with water injection in nasointestinal tube placement in elderly patients with severe diseases[J]. Chinese Journal of Geriatrics Research(Electronic Edition), 2022, 09(02): 27-30.

目的

探讨超声定位联合渐进式注水法在老年重症患者鼻肠管置管中的应用价值。

方法

选择2018年1至10月在浙江医院重症医学科行经鼻肠管肠内营养支持的老年重症患者52例为研究对象。置管过程中使用床旁超声联合渐进式注水法引导鼻肠管置入，并在不同解剖位置定位鼻肠管头端。以腹部X线检查确认鼻肠管头端位于幽门后作为成功置管的标准。计算置管成功率，超声定位法的敏感度、特异度、阳性预测值、阴性预测值及准确性。

结果

52例老年重症患者中48例（92.3%）置管成功，其中46例（88.5%）一次性置管成功，平均置管时间为（21.0±4.7）min；4例（7.7%）置管失败，经腹部X线确认均为胃内打折。48例置管成功患者中有46例使用超声定位成功，2例幽门后未探及鼻肠管声影。超声定位法的敏感度、特异度、阳性预测值、阴性预测值和准确性分别为95.8%、100.0%、100.0%、67.0%、96.2%。

结论

超声定位联合渐进式注水法能快速、准确、安全地引导老年重症患者鼻肠管置入，具有较好的临床应用价值。

关键词: 重症监护, 超声检查, 插管法，胃肠
Objective

To explore the value of ultrasound localization combined with water injection in nasointestinal intubation in elderly patients with severe diseases.

Methods

A total of 52 elderly critically ill patients admitted to Zhejiang Hospital from January 2018 to October 2018 who underwent enteral nutrition support were selected as subjects. Ultrasound-guided water injection is used to guide the placement of the nasointestinal tube. Ultrasound positioning of the nasointestinal tube at different anatomical locations was performed during catheterization. When abdominal X-ray examination confirmed that the head of naso intestinal tube was located behind the pylorus, the catheterization was successful. Calculate the success rate of catheterization, sensitivity, specificity, positive predictive value, negative predictive value and accuracy of ultrasonic localization.

Results

Among the 52 elderly patients, 48 cases were successfully catheterized, and the success rate was 92.3%. Among them, 46 cases (88.5%) had successful one-time tube placement, and the average tube placement time was (21.0±4.7) min. Four cases (7.7%) failed to place the tube, and the abdominal X-ray examination confirmed the tube was folded in stomach. The 48 elderly patients who underwent successful catheterization, 46 were successfully located with ultrasound, and the nasointestinal tube was not located at pylorus in 2 cases. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the ultrasonic localization method were 95.8%, 100.0%, 100.0%, 67.0%, and 96.2%, respectively.

Conclusion

Ultrasound localization combined with water injection can quickly, accurately and safely guide the nasointestinal tube placement in elderly critically ill patients.

Key words: Intensive care, Ultrasonography, Intubation, gastrointestinal
图1 不同位置鼻肠管超声显影。图1A为纵切面显示鼻肠管位于食管内；图1B为鼻肠管在胃内显影；图1C为鼻肠管在十二指肠球部显影；图1D为鼻肠管在十二指肠水平部显影。箭头所示为鼻肠管 注：STO指胃部；GB指胆囊；DB指十二指肠球部
图2 鼻肠管位于胃窦部时注水前后的超声显像。图2A为注水前胃窦部显像；图2B为注水后胃窦部出现"云雾征"，向患者右侧扩散。箭头所示为"云雾征"
图3 鼻肠管通过幽门时注水前后的超声显像。图3A为注水前幽门部显像；图3B为注水后"云雾征"由患者右侧向左侧扩散。箭头所示为"云雾征"
表1 超声定位法对鼻肠管位置的判断情况（例）
超声定位法 腹部X线检查 合计
幽门后置管 非幽门后置管
幽门后置管 46 0 46
非幽门后置管 2 4 6
合计 48 4 52
[1]
Casaer MP, van den Berghe G. Nutrition in the acute phase of critical illness[J]. N Engl J Med, 2014, 370(13):1227-1236.
[2]
Zhu Y, Yin H, Zhang R, et al. Gastric versus postpyloric enteral nutrition in elderly patients (age≥ 75 years) on mechanical ventilation: A single-center randomized trial[J]. Crit Care, 2018, 22(1):170.
[3]
Singer P, Blaser AR, Berger MM, et al. ESPEN guideline on clinical nutrition in the intensive care unit[J]. Clin Nutr, 2019, 38(1):48-79.
[4]
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.
[5]
Gok F, Kilicaslan A, Yosunkaya A. Ultrasound-guided nasogastric feeding tube placement in critical care patients[J]. Nutr Clin Pract, 2015, 30(2):257-260.
[6]
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.
[7]
Zatelli M, Vezzali N. 4-Point ultrasonography to confirm the correct position of the nasogastric tube in 114 critically ill patients[J]. J Ultrasound, 2016, 20(1):53-58.
[8]
Wong KW, Chan HH, Wong CP, et al. Using color flow detection of air insufflation to improve accuracy in verifying nasogastric tube position[J]. Am J Emerg Med, 2017, 35(2):333-336.
[9]
Yıldırım Ç, Coşkun S, Gökhan Ş, et al. Verifying the placement of nasogastric tubes at an emergency center: Comparison of ultrasound with chest radiograph[J]. Emerg Med Int, 2018, 20(2):1-6.
[10]
Mizzi A, Cozzi S, Beretta L, et al. Real-time image-guided nasogastric feeding tube placement: A case series using kangaroo with IRIS technology in an ICU[J]. Nutrition, 2017, 37(6):48-52.
[11]
郁慧杰，徐小琴，许嵩翱，等. B超监视联合胃内注气法在神经外科危重患者鼻空肠管留置中的应用[J].中华医学杂志，2015，95（7）：527-529.
[12]
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.
[13]
叶瑞忠，杨向红，冯治文，等.混合超声造影在重症患者鼻肠管定位中的应用价值[J/CD].中华医学超声杂志（电子版），2019，16（2）：87-94.
[14]
孙建华，王小亭，张青，等.超声引导联合胃窦渐进式注水法在鼻肠管放置中的应用[J].中华护理杂志，2017，52（12）：1418-1421.
[15]
邢小康，李曼，郭丰.胃肠超声联合气水交替注射法对重症患者鼻肠管定位的价值[J].中华临床营养杂志，2018，26（6）：349-353.
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