超声引导胃窦冲击法联合"四眼征"定位置入鼻肠管在重症患者中的应用效果分析  

Clinical application of water-filling with"four-eyes"sign under the guidance of ultrasound in nasal-jejunum intubation for critical patients

作　　者：杨清[1,2] 曹岚[1] 刘志勇[2] 孙杨[2] 田盾 殷俊[2] 黄艳[2] Yang Qing;Cao Lan;Liu Zhiyong;Sun Yang;Tian Dun;Yin Jun;Huang Yan(Teaching and Research Section of Clinical Nursing,Xiangya Hospital,Central South University,National Clinical Research Center for Geriatric Disorders,Critical Care Ultrasound Study Group,Changsha 410008,China;Department of Critical Care Medicine,Xiangya Hospital,Central South University,National Clinical Research Center for Geriatric Disorders,Critical Care Ultrasound Study Group,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院临床护理学教研室、国家老年疾病临床医学研究中心、重症超声研究组,长沙410008 [2]中南大学湘雅医院重症医学科、国家老年疾病临床医学研究中心、重症超声研究组,长沙410008

出　　处：《中国实用护理杂志》2023年第15期1121-1127,共7页Chinese Journal of Practical Nursing

基　　金：中南大学研究生教育教学改革研究项目(2022JGB124)。

摘　　要：目的探讨超声引导胃窦冲击法联合"四眼征"定位置入鼻肠管在重症患者中的应用效果。方法本研究为随机对照试验。选取2021年6月至2022年4月在中南大学湘雅医院重症医学科需留置鼻肠管的患者80例,按系统随机化法分为对照组和试验组各40例,试验组采取超声引导胃窦冲击法联合"四眼征"定位置入方法,对照组采取传统超声引导置入方法。2组最后以腹部X线示鼻肠管过幽门为置管成功金标准。统计2组患者置管情况、操作耗时、定位的效能等相关指标。结果试验组成功置入38例,失败2例,对照组成功置入27例,失败13例,对照组失败后使用试验组方法再次置管,均置入成功。试验组置管成功率为95.0%(38/40),高于对照组的67.5%(27/40),差异有统计学意义(χ^(2)=9.93,P<0.05)。试验组操作耗时(45.2±14.2)min,显著低于对照组的(70.2±17.7)min,差异有统计学意义(t=-5.51,P<0.05)。试验组鼻肠管定位的特异度、敏感度、阳性预测值、阴性预测值、诊断符合率均为100.0%,高于对照组的38.4%、77.7%、72.4%、45.4%、65.0%;试验组假阳性率、假阴性率均为0,低于对照组的22.2%、61.5%,差异均有统计学意义(χ^(2)值为4.69~16.97,均P<0.05)。结论超声引导胃窦冲击法联合"四眼征"定位置入法是床旁超声引导下的一种创新鼻肠管置入技术,该方法能明显缩短床旁鼻肠管的放置时间,提高置管成功率,且有较高的定位准确率,具有较高的临床应用价值。Objective To evaluate the clinical application of water-filling with"four-eyes"sign under the guidance of ultrasound in nasal-jejunum intubation for critical patients.Methods This study was a randomized controlled trial.Eighty patients who needed indwelling nasobenteric tube were selected from June 2021 to April 2022 in the Department of Critical Care Medicine,Xiangya Hospital,Central South University.They were divided into control group(n=40)and experimental group(n=40)by systemic randomization.For the patients in the experimental group,the intubation was performed by water-filling with"four-eyes"sign under the guidance of ultrasound.For the control group,the traditional method was applicated under the guidance of ultrasound.Using abdominal X-ray as the gold standard of successful pylorus posterior catheterization,the result of catheterization,time of operation,efficiency of positioning in the two groups were analyzed and compared.Results In the experimental group,38 cases were successfully intubated,2 were failed;in the control group,27 cases were successfully intubated,13 were failed,and all the failed cases in the control group were then successfully intubated again by using method of the experimental group.The success rate of tube placement in the experimental group was 95.0%(38/40),which was higher than 67.5%(27/40)in the control group(χ^(2)=9.93,P<0.05).The average time of operation in the experimental group was(45.2±14.2)min,which was significantly lower than(70.2±17.7)min in the control group,the difference was significantly different(t=-5.51,P<0.05).The specificity,sensitivity,positive predictive value,negative predictive value and diagnostic rate of nasal-jejunum intubation positioning in the experimental group were 100.0%respectively,higher than 38.4%,77.7%,72.4%,45.4%,65.0%in the control group;the false positive rate,false negative rate in the experimental group were both 0,lower than 22.2%,61.5%in the control group,with statistically significant differences(χ^(2) values were 4.69-16.97,all P<0.0

关 键 词：回声定位 超声检查 介入性 鼻肠管 超声引导 胃窦冲击法 四眼征 

分 类 号：R459.7[医药卫生—急诊医学]