床旁超声引导下幽门定位及其在鼻空肠管置入术中的应用  

Localization of pylorus under the guidance of bedside ultrasound and its clinical application in nasal-jejunum intubation for critical patients

作　　者：徐程[1] 黄中伟[2] 蒋海燕[2] 顾玉慧[2] 袁鼎山[2] 祁雷[2] 

机构地区：[1]南通大学附属医院医学超声科 [2]南通大学附属医院急诊医学科,江苏南通226001

出　　处：《解剖学报》2017年第4期440-444,共5页Acta Anatomica Sinica

基　　金：南通市重点病种临床规范化诊疗项目(MS32015032)

摘　　要：目的评价床旁超声引导下幽门定位的可行性及其在危重症患者鼻空肠管置入中的临床应用价值。方法以30例需肠内营养的危重病患者为研究对象,随机分成床旁超声引导组(15例)和盲插组(15例),床旁超声引导组行床旁超声引导下鼻空肠管的置管,盲插组行床旁盲插法鼻空肠管置入。观察床旁超声引导下幽门定位情况及两组患者鼻空肠管置管时间、置管相关并发症发生和医疗费用情况。结果两组患者年龄、性别、APACHE II评分、诊断相比较,差异无显著性(P>0.05)。两组到达胃部时间相比较,差异无显著性(P>0.05)。床旁超声引导组通过幽门时间明显低于盲插组,差异具有显著性(P<0.01)。床旁超声引导组医疗费用明显少于盲插组,差异具有显著性(P<0.01)。结论床旁超声引导下鼻空肠管的置入明显优于盲插法,在置管过程中结合床旁超声可准确定位幽门位置,实时监测导管头端位置,精确了解导管头端和幽门的相对位置,对缩短耗时,减少费用,提高幽门通过率具有广泛的临床应用价值。Objective To evaluate the clinical application of bedside ultrasound in pyloric localization and nasaljejunum tube intubation in critical patients. Methods A total of 30 critical patients were randomly divided into bedside ultrasound group（ n = 15） and blind insertion group（ n = 15）. The bedside ultrasound group underwent the intubation of nasal-jejunum tube by the guidance of bedside ultrasound,and the blind group underwent traditional blind insertion method. The localization of the pylorus was described by using bedside ultrasound. The time of tube intubation,tube related complications and medical expenses of the two groups were observed. Results There was no significant difference in the sex,age and the acute physiology and chronic health evaluation（ APACHE II） score between the bedside ultrasound group and the blind group（ P 〉 0. 05）. A significant difference was found in the time consumption of intubation between the two groups（ P 〈 0. 01）. There was no significant difference in tube related complications between the two groups.Significant difference（ P 〈 0. 01） was found in medical expenses of the two groups. Conclusion The bedside ultrasound guidance method has definite advantages in pyloric localization and in intubation of nasal-jejunum tube for critical patients in comparison with the traditional blind insertion method.

关 键 词：鼻空肠管 超声引导 幽门定位 人 

分 类 号：R4[医药卫生—临床医学]