十二指肠球部超声解剖定位法对重症患者鼻肠管幽门后置管的快速判断价值  

Quick confirmation of nasointestinal tube placed below pylorus in critically ill patients by duodenal bulb ultrasonic anatomy locating method

作　　者：叶瑞忠[1] 范小明[1] 孙仁华[2] 张帆[1] 王立刚[1] 曾增[1] 刘阳[1] 呼邦传[2] 屠越兴[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：《中华医学杂志》2017年第17期1312-1315,共4页National Medical Journal of China

摘　　要：目的探讨十二指肠球部超声解剖定位法对重症患者鼻肠管幽门后置管快速判断的价值。方法选择2016年3月1日至8月1日浙江省人民医院重症医学科的重症患者56例，行盲插法鼻肠管置入术，置管过程中，通过超声解剖定位法快速探查并定位十二指肠球部，同时观察其内部是否可见鼻肠管声像图，如有则提示幽门后置管成功。如遇伪像干扰或其他原因无法确定为鼻肠管时，向管腔内注入空气，呈现为条状强回声可予以明确。必要时行胃肠减压或应用胃肠动力药物以减轻腹腔或肠道气体的干扰。超声结果与腹部X线片进行对照，以验证该方法的准确性，同时记录耗时及相关并发症。结果53例（94．6％）通过超声解剖定位法快速获得十二指肠球部的定位，耗时（42±23）s。52例（92．9％）通过超声探及十二指肠球部内鼻肠管回声确认幽门后置管成功，耗时（140±94）s。所有患者在鼻肠管置管及超声定位过程中均未出现明显并发症。结论通过十二指肠球部超声解剖定位法可快速判断鼻肠管是否成功实现幽门后置管，安全、简便、准确率高，值得临床推广应用。Objective To investigate the value of duodenal bulb ultrasonic anatomy locating method quickly confirm nasointestinal tube placed below pylorus in critically ill patients. Methods A total of 56 critically ill patients with nasointestinal tube posting surgery by blindly inserting method were collected from March 1 st,2016 to August 1 st,2016 in the Department of Critical Care Medicine of Zhejiang Provincial People＇s Hospital. In these patients, the duodenal bulbs were rapidly detected and located by ultrasonic anatomy locating method and at the same time observed whether nasointestinal tube echogram were in them or not. If nasointestinal tube echogram was observed in duodenal bulbs that meant nasointestinal tube placed below pylorus successfully. If disturbed by ultrasound artifacts or other reasons, injected gas into the nasointestinal tube could help to confirm when hyperechoic strip emerged. Gastrointestinal decompression or gastrointestinal motion promoting drug could help to reduce the interference of abdominal cavity or bowel gas if necessary. The results were compared with the abdominal X examination to vertify the accuracy of this method, and at the same time recorded its total time-consuming and its related complications. Results The duodenal bulbs were rapidly located by ultrasonic anatomy locating method in 53 cases （ 94. 6% ） timeconsuming（42 ± 23 ）s. Nasointestinal tubes observed in duodenal bulb were confirmed to be placed below pylorus successfully in 52 cases（92. 9% ）time-consuming（ 140 ± 94）s. There were no obvious complications in all patients. Conclusion Duodenal bulb ultrasonic anatomy locating method is a safe, simple and convenient method with high accuracy that can quickly confirm whether nasointestinal tube placed below pylorus in critically ill patients or not.

关 键 词：重症监护 超声检查 插管法 胃肠 

分 类 号：R445.1[医药卫生—影像医学与核医学] R459.7[医药卫生—诊断学]