注气听诊法及pH试纸检测法在外科重症患者床边放置鼻肠管中的应用  

Evaluation of gas-stimulated auscultation and pH test during the bedside placement of nasointestinal tube in surgical critically ill patients

作　　者：万晓[1] 习丰产[2] 虞文魁[2] 朱志强[1] 

机构地区：[1]安徽医科大学附属省立医院普通外科,合肥230001 [2]南京军区总医院普通外科研究所

出　　处：《中国临床保健杂志》2017年第2期128-131,共4页Chinese Journal of Clinical Healthcare

基　　金：国家自然科学基金(81270884)

摘　　要：目的探讨注气听诊法、pH试纸检测法判断外科重症患者床边放置鼻肠管的准确性及影响因素。方法采用标准操作流程为60例外科重症患者行床边放置鼻肠管,同时分别用注气听诊法、pH试纸检测法进行床边判定,记录判定结果;放置结束每例患者再采用影像学方法作为判定鼻肠管位置金标准。检测质子泵抑制剂类药物的使用对pH试纸检测法判定准确率的影响。结果累计为60例患者放置鼻肠管,置管成功38例,失败22例。注气听诊法及pH试纸检测法均提示在位组置管成功率显著高于单项提示组和未提示组,差异有统计学意义(P<0.01);此外,质子泵抑制剂的使用显著降低pH试纸检测法的准确性(P<0.01)。结论行床边盲放鼻肠管时,当且仅当注气听诊法、pH试纸检测法均提示在位才有较高的置管成功率;使用质子泵抑制剂显著降低了pH试纸检测法准确性。Objective To investigate the accuracy and influencing factors of gas-stimulated auscultation and pH test during the bedside placement of nasointestinal tube in surgical critically ill patients. Methods The nasointesti-nal tubes were placed in 60 surgical critically ill patients according to the standard bedside placement procedure. At the same time,the position of each tube was assessed by gas-stimulated auscultation and pH test,all the results were recor-ded. Radiology method was adopted as the gold standard for evaluating the nasoenteral postion after the placement. Results A total of 60 patients were placed the nasointestinal tubes,38 cases succeed,and 22 cases failed. The combi-nation of both positive gas-stimulated auscultation and pH test demonstrate a higher rate of successful tube placement than the other three groups （ P 〈 0. 01） . In addition, the use of proton pump inhibitors significantly reduced the accuracy of the pH strip assay （P 〈0. 01）. Conclusions A high success rate can be achieved only when the gas-stimulated aus-cultation and pH test both prompt in place during the bedside placement of nasointestinal tube. The use of proton pump inhibitors significantly decreases the accuracy of the pH detection.

关 键 词：插管法 胃肠 肠道营养 听诊 临床化学试验 

分 类 号：R651[医药卫生—外科学]