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  

Experience of Sonography Guided Freka Trelumina Placement in Patients with Severely Impaired Gastric Emptying by Stylet Displacement

作　　者：陈培服[1,2] 唐时元[2] 曹钰[2] 

机构地区：[1]宁波市第二医院重症医学科,浙江宁波315010 [2]四川大学华西医院急诊科

出　　处：《华西医学》2016年第6期1023-1027,共5页West China Medical Journal

基　　金：宁波市医学科技计划项目(2014A06)~~

摘　　要：目的评估使用超声引导下导丝位移法置入三腔喂养管的效果。方法以2016年1月8日-5月18日期间在宁波市第二医院重症监护病房住院的22例存在胃排空障碍的重症患者为研究对象。记录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时的评估指标,包括是否采用胃内注射温开水、导管通过幽门前手法推进次数、引导置管是否成功、引导置管时间、置管深度等。分析该方法在临床使用的优劣以及是否空腹对置管时间的影响。结果在22例患者中,置管成功20例,成功率91%。三腔喂养管推进时,分别以1次、2次及≥3次通过幽门的例数为4例(20%)、5例(25%)、11例(55%)。其中超声下可见十二指肠水平部导管影9例(45%)。置管成功患者的引导置管时间为(20.35±12.93)min。其中空腹患者11例,引导置管时间(15.00±9.87)min;非空腹患者9例,引导置管时间(26.89±14.45)min,两组置管时间差异有统计学意义(P<0.05)。结论采用超声引导下导丝位移法在胃排空障碍的重症患者中置入三腔喂养管的成功率高。而患者空腹状态下置管,可能有助于减少操作时间。Objective To assess the clinical efficacy of sonography guided Freka Trelumina placement by styler displacement in patients with severely impaired gastric emptying. Methods Twenty-two patients with severely impaired gastric emptying monitored in the Intensive Care Unit from January 8 to May 18, 2016 were chosen to be our study subjects. Freka Trelumina was placed under ultrasonic guidance, and the guide wire displacement was used to determine the location of the catheter. We recorded whether the patient had an intra-gastric injection of warm water, the manual pushing times before the catheter passed through the pylorus, whether the operation succeeded, the time spent on guiding the placement, and the catheter depth. The pros and cons of the method in clinical use, and whether fasting state helped reduce the operating time were analyzed. Results Among the 22 patients, 20 had a successful Freka Trelumina placement, and the success rate was 91%. The number of manual pushing before the catheter passed through the pylorus was I in 4 cases （20%）, 2 in 5 （25%）, and equal to or more than 3 in 11 cases （55%）. The catheter could be seen in the third part of duodenum only in 9 cases （45%）. The mean placement procedure lasted （20.35±12.93） minutes for the successful cases. The time spent in the 11 patients with empty stomach was （15.00±9.87） minutes, less than （26.89± 14.45） minutes in those 9 post prandial patients （P〈 0.05）. Conclusions With stylet displacement to determine the location of the catheter, sonography guided Freka Trelumina placement has a high success rate. Ultrasonic guidance facilitates theinsertion of the tubes in critically ill patients. For patients with empty stomach, it may help reduce the operating time.

关 键 词：超声引导 三腔喂养管 鼻肠管 肠内营养 危重病 胃排空障碍 

分 类 号：R459.7[医药卫生—急诊医学] R459.3[医药卫生—治疗学]