改良超声方法在重症患者留置鼻肠管头端定位中的初步应用  

Preliminary application of modified ultrasound method in locating indwelling nasointestinal tube end in critically ill patients

作　　者：叶瑞忠[1] 范小明[1] 王立刚[1] 张帆[1] 龙才权 孙仁华[2] 徐良[2] 赵辉[2] 

机构地区：[1]浙江省人民医院超声科,杭州310014 [2]浙江省人民医院重症医学科,杭州310014

出　　处：《中华临床营养杂志》2016年第4期199-202,共4页Chinese Journal of Clinical Nutrition

摘　　要：目的探讨利用改良后的超声方法在重症患者留置鼻肠管头端定位中的有效性。方法2015年9月1日至2016年3月1日浙江省人民医院重症医学科已留置鼻肠管的肠内营养重症患者21例，利用常规超声探查鼻肠管的走行，如遇伪像干扰或其他原因无法确定为鼻肠管时，于鼻肠管内注入空气，呈现为条状强回声可予以明确。超声实时监测可疑鼻肠管头端处，快速向鼻肠管内注入胃窗声学对比剂，如该处肠腔可见对比剂充盈，肠管扩张，则提示为鼻肠管头端所在位置。将定位结果与腹部X片进行对照，一致者代表定位成功。结果21例患者通过改良的超声方法定位鼻肠管头端成功率90．5％（19／21），其中一次性成功定位16例，所需时间为（7±2）min，3例需多次鼻肠管灌气扫查走行或灌注胃窗对比剂定位头端，所需时间为（15±3）min，均未出现明显并发症。结论通过改良的超声检查方法可有效监测重症患者留置鼻肠管的走行及头端定位，缩短耗时，具有较好的临床应用价值。Objective To evaluate the effectiveness of modified ultrasound method in locating indwell- ing nasointestinal tube end in critically ill patients. Methods 21 critically ill patients who had nasointestinal tube indwelled were collected from September 1st, 2015 to March 1st, 2016 in Intensive Care Unit of Zhejiang Province People＇s Hospital. In these patients, directions of nasointestinal tubes were detected using conventional ultrasound. When disturbed by artifacts or other reasons, gas was filled into the nasointestinal tube to help con- firm it if hyperechoic strip was observed. With suspicious nasointestinal tube end monitored by real-time ultra- sound, stomach window ultrasound contrast agent was quickly injected into the tube, the position of nasointesti- nal tube end was confirmed where ultrasound contrast agent filling and intestinal cavity dilating were observed. The results were compared with the abdominal X-ray examination, good agreement between the two methods was defined as successful locating. Results The nasointestinal tube end was successfully located by modified ultra- sound method in 90. 5% （ 19/21 ） of the patients collected in this study, including success at one attempt in 16 cases, with the time required in positioning being （7 ＋ 2） minutes; and success after multiple gas filling or ul- trasound contrast agent injection to confirm the position of tube end in 3 cases, with the time required being （ 15 ~ 3） minutes. There were no obvious complications in these patients. Conclusion Direction and end po- sition of nasointestinal tube in critically ill patients can be effectively monitored using modified ultrasound meth- od, which may shorten the operation time and has favorable clinical application value.

关 键 词：重症监护 插管法 胃肠 超声检查 造影剂 

分 类 号：R459.3[医药卫生—治疗学]