超声成像技术评估气管内插管定位在危重早产儿中的应用  

Application of ultrasound imaging technology to evaluate the localisation of endotracheal intubation in critically ill premature infants

作　　者：左莉莉[1] 任义梅[1] 管亚飞[1] 龚丽玲 颜琪 陈筱青[1] ZUO Li-li;REN Yi-mei;GUAN Ya-fei;GONG Li-ling;YAN Qi;CHEN Xiao-qing(Department of Pediatrics,the First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu 210029,China)

机构地区：[1]南京医科大学第一附属医院儿科,江苏南京210029

出　　处：《中华全科医学》2022年第8期1283-1286,共4页Chinese Journal of General Practice

基　　金：国家自然科学基金面上项目(81871195)。

摘　　要：目的探讨超声成像技术评估危重早产儿气管内插管定位的临床应用效果。方法选择2019年1月—2021年1月于南京医科大学第一附属医院新生儿监护病房住院并接受气管内插管术的103例早产儿为研究对象,以定位气管内插管方式的不同,分为超声定位组(50例)和以听诊肺部及胃泡判断气管导管在位的对照组(53例),导管固定后均采用胸部X线评估导管的位置。观察并分析超声组声像图特征,比较组间定位气管导管适宜率、误入食管率、误入主支气管(置管过深)率、脱管(置管过浅)率,评价2种方式定位导管的准确性。结果超声组定位导管适宜率(86.0%vs.54.7%,P=0.001)高于对照组,误入主支气管率(6.0%vs.20.8%,P=0.029)、脱管率(4.0%vs.17.0%,P=0.033)低于对照组;以X线定位气管导管位置适宜为金标准,2组定位方式为筛查标准,发现超声组定位灵敏度(91.1%vs.88.9%)、特异度(80.0%vs.11.8%)、约登指数(71.1%vs.6.5%)及Kappa一致性系数(0.561 vs.0.008)均明显高于对照组。结论超声成像技术评估气管导管定位实时、有效,可准确判断导管位置及深度,减少放射性暴露累积,值得在危重早产儿中推广应用。Objective To evaluate the clinical application of ultrasound imaging technology in the localisation of endotracheal intubation in critically ill preterm infants.Methods A total of 103 critically ill premature infants who received endotracheal intubation in the neonatal intensive care unit of the First Affiliated Hospital of Nanjing Medical University from January 2019 to January 2021 were selected as the research object.By different methods of positioning endotracheal tube,they were divided into ultrasound group(50 cases)and control group(53 cases)by auscultation of lung and gastric vesicle.After the catheter was fixed,the catheter's position was evaluated by chest X-ray.The ultrasonographic characteristics of the ultrasound group were observed and analysed.Moreover,the suitability rate of endotracheal tube positioning and the rates of mistakenly entering the oesophagus and main bronchus(catheterisation too deep)and detubation(catheterisation too shallow)were compared between the two groups to evaluate the accuracy of endotracheal tube positioning by different methods.Results The suitability rate of catheter positioning in the ultrasound group was higher than that in the control group(86.0%vs.54.7%,P=0.001).The rates of mistakenly entering the main bronchus(6.0%vs.20.8%,P=0.029)and detubation(4.0%vs.17.0%,P=0.033)were lower than those in the control group(P<0.05).The suitability of X-ray localisation of endotracheal tube was taken as the gold standard,and the localisation mode of the two groups was considered as the screening standard.The Youden index(71.1%vs.6.5%),sensitivity(91.1%vs.88.9%),specificity(80.0%vs.11.8%)and Kappa consistency coefficient(0.561 vs.0.008)in the ultrasound group were significantly higher than those in the control group.Conclusion Ultrasound imaging technology can effectively evaluate the positioning of the endotracheal tube in real time.It can accurately judge the position and depth of the endotracheal tube and reduce the accumulation of radiation exposure.It is worthy to be popularised

关 键 词：超声成像技术 气管内插管 定位 早产儿 

分 类 号：R722.6[医药卫生—儿科]