不同急性胃肠损伤分级下危重患者两种鼻空肠管置管方法效果的比较

Comparison of two nasal-jejunal tube placement methods in critically ill patients with different acute gastrointestinal injury grades

目的对比不同急性胃肠损伤(AGI)分级下危重患者两种鼻空肠管置管方法的效果,探讨AGI分级对鼻空肠管置管方法选择的指导价值。方法前瞻性分析我院重症医学科收治的156例急性胃肠损伤患者,根据AGI分级标准分为Ⅰ级30例,Ⅱ级48例,Ⅲ级50例,Ⅳ级28例,并随机分为治疗组及对照组,治疗组行床旁超声引导下鼻空肠管置入术,对照组行床旁盲插法鼻空肠管置入术,观察AGI不同分级时两组患者鼻空肠管置管成功率、成功置入时间,分析AGI分级与置管成功率及置管时间的相关性。结果AGI分级为Ⅰ级的患者中,两组置管成功率均较高且差异无统计学意义(93.8%vs92.9%);AGI分级为Ⅱ级、Ⅲ级的患者中,治疗组置管成功率均高于对照组,差异有统计学意义(P<0.05);AGI分级为Ⅳ级患者中,治疗组与对照组置管成功率均较低且差异无统计学意义。AGI分级为Ⅰ级、Ⅱ级及Ⅲ级成功置管患者,治疗组置管时间少于对照组(P<0.05);AGI分级为Ⅳ级患者中,治疗组平均置管时间与对照组相比差异无统计学意义。AGI分级与置管成功率无显著相关性,治疗组AGI分级与置管时间呈正相关(P<0.05),对照组AGI分级与置管时间无显著相关性。结论 AGI分级为Ⅰ、Ⅱ、Ⅲ级患者,超声引导下鼻空肠管置管明显优于盲插法,且前者置管时间与AGI分级正相关,提示AGI分级标准可用于指导鼻空肠管置管方式的选择。

Objective To compare two asal-jejunal tube placement methods in critically ill patients with different acute gastrointestinal injury （AGI） grades, so as to discuss the value of AGI grading in selection of asal-jejunal tube placement. Methods A total of 156 patients with acute gastrointestinal injury in Intensive Care Unit （ICU） were observed prospectively; they included 30 cases of grade I , 48 cases of grade Ⅱ , 50 cases of grade Ⅲ and 28 cases of grade IV according to the AGI grading system. And then the patients were randomly divided into treatment group and control group. The treatment group was given bedside ultrasound-guided nasal-jejunal tube placement, and the control group underwent bedside blind nasal jejunal tube placement. The success rate and average time of placement were observed in the two groups with different AGI grades, and then the correlation among AGI grading system, success rate and average time of placement were also analyzed in the two groups. Results The success rate of placement was high in AGI grade I patients of the two groups, and there was no significant difference between the two groups（93. 8% vs 92. 9%）. The success rates for AGI grade Ⅱ and grade Ⅲ patients of the treatment group were significantly higher than those of the control group（P〈0. 05）. The successful placement rates were lower in AGI grade IV patients of the two groups and there was no significant difference between them. The average time of successful placement in AGI grades I , Ⅱ , and Ⅲ patients of the treatment group were significantly shorter than that of the control group （P〈0. 05） ; but there was no significant difference in AGI grade 1V patients between the two groups. There was no significant correlation between AGI grade and successful placement rate. There was a positive correlation between AGI grade and the average placement time in the treatment group （P（0.05）, but not in the control group. Conclusion Ultrasound-guided nasal-jejunal tube placement is obviously better than the blind method for AGI grade I , Ⅱ , Ⅲ patients. The average time of ultrasound-guided nasal-jejunal tube placement is positively correlated with AGI grade, suggesting AGI grading system can help to choose naso-jejunal tube placement method.