危重症患儿经鼻放置胃管长度预测量准确性研究

Accuracy of prediction amount of length of gastric tube placed through nose in critically ill children

目的通过对危重症患儿鼻胃管放置长度测量的临床观察,提高鼻胃管放置预测量的准确性,降低不良事件的发生。方法采用便利抽样法,选取2019年4—9月首都医科大学附属北京儿童医院儿童重症监护病房(PICU)住院的需要放置鼻胃管的危重症患儿,采用“鼻尖-耳垂-剑突的距离(NEX)再增加5 cm”(NEX+5 cm)预测量方法。比较本研究置入长度数值与传统测量法(即NEX)、改良的“鼻尖-耳垂-剑突-脐中点法”(NEMU)、公式法预测置入长度的数值。结果本研究共纳入52例危重症患儿,鼻胃管置入长度为31.5(28.3,35.8)cm,其中经X线判定为位置合格者43例(82.7%)。NEX法测得患儿需置入胃管长度为27.0(24.1,31.0)cm,公式法测得患儿需置入胃管长度为26.1(22.5,29.0)cm,两者均小于NEX+5 cm测量的长度,差异有统计学意义(P<0.01)。NEMU法测得患儿需置入胃管长度为31.0(28.3,36.0)cm,与NEX+5 cm测量的长度比较,差异无统计学意义(P>0.05)。结论本研究使用NEX+5 cm预测经鼻置入胃管实际长度的准确性较高,操作方法简便。在临床应用时需考虑个体差异,特别是婴幼儿变异度大,置管后应使用腹部超声、X线等辅助检查方法确定置管位置,并结合不同治疗目的给予患儿个体化的置管方案。

Objective To improve accuracy of prediction amount of length of gastric tube placed through nose and reduce occurrence of adverse events thorough clinical observation of measurement of length of nasogastric tube placement in critically ill children.Methods Using the convenient sampling method,critically ill children who were hospitalized and needed a nasogastric tube in Pediatric Intensive Care Unit(PICU)of Beijing Children's Hospital Affiliated to Capital Medical University were selected from April to September 2019.The prediction method of"nos-ear-xiphoid(NEX)increased by 5 cm"(NEX+5 cm)was adopted.The values of placed length in this study were collected and compared with those predicted by traditional measurement method(namely NEX),improved"nose-ear-mid-umbilicus"(NEMU)and formula method.Results A total of 52 critically ill children were enrolled in this study.The length of placed nasogastric tube was 31.5(28.3,35.8)cm,and 43 cases(82.7%)were determined to be qualified by X-ray.The length of gastric tube required to be placed in children was 27.0(24.1,31.0)cm according to the NEX method,and the length of gastric tube required to be placed in children was 26.1(22.5,29.0)cm measured by the formula method.Both were shorter than that measured by NEX+5 cm,and the differences were statistically significant(P<0.01).The NEMU method measured the length of gastric tube to be inserted into the child to be 31.0(28.3,36.0)cm.Compared with the length measured by NEX+5 cm,and the difference was not statistically significant(P>0.05).Conclusions This study uses NEX+5 cm to predict the actual length of the gastric tube inserted through the nose.The accuracy is relatively high and the operation method is simple.It is necessary to consider individual differences in clinical applications,especially the large variability in infants and young children.After catheterization,abdominal ultrasound,X-ray and other auxiliary examination methods should be used to determine the location of catheterization,and individualized catheterization programs should be given to children according to different therapeutic objective.