集成实时成像技术在成人危重症病人鼻肠管置管中的应用研究  

A study on the application of integrated real-time imaging in nasoenteric tube placement in adult critically ill patients

作　　者：张敏[1] 陆素英[1] 韩小云[2] 吴智水 杨靖 陈建芬[1] 郑峰[3] ZHANG Min;LU Su-ying;HAN Xiao-yun;WU Zhi-shui;YANG Jing;CHEN Jian-fen;ZHENG Feng(Department of Intensive Care Unit,the First People's Hospital of Changzhou,Changzhou 213000,Jiangsu,China;Nursing department,the First People's Hospital of Changzhou,Changzhou 213000,Jiangsu,China;Medical department,the First People's Hospital of Changzhou,Changzhou 213000,Jiangsu,China)

机构地区：[1]常州市第一人民医院重症医学科,江苏常州213000 [2]常州市第一人民医院护理部,江苏常州213000 [3]常州市第一人民医院医务科,江苏常州213000

出　　处：《肠外与肠内营养》2023年第6期357-362,共6页Parenteral & Enteral Nutrition

摘　　要：目的:探讨基于集成实时成像技术的床旁可视化鼻肠管置管用于成人危重病人的安全性及有效性。方法:本研究为单中心随机对照研究,以2022年1月至2022年12月就诊于常州市第一人民重症医学科需要留置鼻肠管行肠内营养的危重病人为研究对象,按照计算机生成的随机序列将其分为试验组和对照组,试验组采用可视化鼻肠管置管,对照组采用床旁盲插鼻肠管置管,两组病人置管后均采用X线腹部平片确认管道尖端位置,比较两组病人置管并发症(包括鼻黏膜出血、胃肠黏膜出血、误入病人气道、生命体征警报事件)的发生率、首次幽门后置管成功率、置管时间及X线摄片符合率。结果:共纳入108例病人,试验组和对照组病人均为54例,两组病人置管总并发症发生率分别为16.67%、40.74%,其中误入病人气道发生率分别为,0、16.67%,首次幽门后置管成功率分别为90.74%,59.26%,置管时间分别为(21.15±18.16)min,(29.63±17.29)min,差异均有统计学意义(P<0.05),试验组和对照组的X线摄片符合率分别为100%,88.89%,Kappa值分别为1.000,0.770。结论:利用集成实时成像技术辅助危重病人床边可视化鼻肠管置管可降低置管总并发症发生率,尤其可降低误入病人气道的风险,提高首次幽门后置管成功率、缩短置管时间,且与X线摄片符合率高,尤其适用于AGI分级I级-III级的危重病人。Objective:To investigate the safety and efficacy of bedside visualization of nasoenteric tube placement for adult critically ill patients based on integrated real-time imaging technology.Methods:The study was a single-center randomized controlled study of critically ill patients who were admitted to the department of intensive care unit of the First People's Hospital of Changzhou from January 2022 to December 2022,and who were in need t a nasogastric tube for enteral nutrition,and who were randomly divided into experimental group and control group according to the computer-generated random sequence.Visual nasogastric tube insertion based on integrated real-time imaging system technology was used in the experimental group,while blind nasogastric tube insertion was used in the control group.After tube placement,X-ray abdominal plain film was used to confirm the position of the tip of the tube,and the incidence of complications of tube placement(including nasal mucosal bleeding,gastrointestinal mucosal bleeding,accidental entry into the patient's airway,and vital sign alarm events),the success rate of the first post-pyloric tube placement,the time of tube placement,and the compliance rate of X-ray radiographs were compared between the two groups of patients.Results:A total of 108 patients were included,54 patients in each group.The total complication rates of intubation in the experimental group and control group was 16.67%vs 40.74%,of which the incidence rate of intubation was 0.00%vs 16.67%,respectively,and the success rate of posterior pyloric intubation was 90.74%vs 59.26%,and the time of tube placement was(21.15±18.16)min vs(29.63±17.29)min,the differences were statistically significant(P<0.05).The compliance rates of radiographs in the experimental group and the control group were 100%vs 88.89%,and the kappa coefficient were 1.000 vs 0.770.Conclusion:The use of integrated real-time imaging technology to assist bedside visual naso-intestinal intubation in critically ill patients can reduce the total complicat

关 键 词：可视化 鼻肠管 置管 重症病人 肠内营养 

分 类 号：R473[医药卫生—护理学] R459.3[医药卫生—临床医学]