重力引导螺旋型鼻肠管空肠置管操作流程及教学歌诀  

Procedure and teaching verse of placement of spiral nasoenteral tube into jejunum by gravity-guiding

作　　者：郭平清[1] 林文清 黄孝锋 李聪沛 董燕芳 陈兰花 陈志华[1] 蔡川奇[1] 陈锡得[1] 吴巧艺[2] 林志鸿[1] 冯少丹[1] Guo Pingqing;Lin Wenqing;Huang Xiaofeng;Li Congpei;Dong Yanfang;Chen Lanhua;Chen Zhihua;Cai Chuanqi;Chen Xide;Wu Qiaoyi;Lin Zhihong;Feng Shaodan(Emergency Medicine Center,the First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,Fujian,China;Trauma Center&Department of Emergency Surgery,the First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,Fujian,China;Department of Cardiac and Vascular Surgery,the First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,Fujian,China)

机构地区：[1]福建医科大学附属第一医院急诊医学中心,福建福州1350005 [2]福建医科大学附属第一医院创伤中心/急诊外科,福建福州1350005 [3]福建医科大学附属第一医院心脏大血管外科,福建福州1350005

出　　处：《中国中西医结合急救杂志》2024年第1期92-94,共3页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：福建省科技计划社会发展引导性(重点)项目(2020Y0032);国家卫生健康委、中国民族卫生协会卫生健康技术重点推广项目(XM202307797)。

摘　　要：为了提高鼻肠管床旁定位的有效性和空肠置管的成功率,根据经典文献,结合自己的操作实践,编写了一个重力引导螺旋型鼻肠管空肠置管的操作流程及教学歌决。歌决内容:肠内营养寓胜算,空肠置管莫等闲。方法多样各神通,大力推广路漫长。半坐吞咽进食管,回抽自如识胃腔。右卧轻张过幽门,左卧低阻到空肠。胃内折返何征象?导管反弹最先见,充气受阻“折返征”,染色定位胜影像。真空试验最敏感,酸碱序变特异强,美蓝试验神答问,三法联用共导航。腹部平片金标准,超声时代仍可参。立体影像整体观,更有断层解疑难。此教学歌决以简明扼要、易于记忆的形式,成为临床手把手鼻肠管置管教学的有力工具。To improve the effectiveness of bedside localization of nasointestinal tube(NIT)and facilitate the placement of nasointestinal tube into jejunum,we established a procedure and composed a teaching verse for bedside placement of nasointestinal tube based on relevant classical literature and our own practices.Verse content:enteral nutrition means a successful strategy to improve the outcome in critically ill patient management,never hesitate to place nasointestinal tubes when necessary.There are several methods to deal with it,but popularizing it remains a long way off.Half-sitting and swallowing into the esophagus,freely withdrawing signifies the stomach cavity.Passing through the pylorus using light tension on the tube in the right lateral decubitus position.Arriving at the jejunum with low resistance in the left lateral decubitus position.What are the signs of intragastric coiling?Tube return out of nose is the initial observation,Failure of air insufflation indicates tube coiling.Dyeing location surpasses imaging.Vacuum test is the most sensitive,Sequential change from acid to base is specific.Methylene blue test is dramatical for localization.Combining three methods is enough to navigate.Abdominal plain film is the goldan standard and can still be used in ultrasonic era.3-D image establishes overall view.CT reveals the tube route exactly.The teaching verse has become a powerful tool for clinical teaching of manual nasointestinal tube placement in a concise and easy-to-remember form.

关 键 词：鼻肠管 螺旋型鼻肠管 空肠置管 肠内营养 歌诀 

分 类 号：R-4[医药卫生]