胃肠超声造影技术联合气体灌注定位鼻肠管的方法学研究

Methodological research of nasointestinal tube positioning confirmed by gastrointestinal contrastenhanced ultrasound combined gas injection

目的:探讨利用胃肠超声造影技术联合气体灌注对危重症病人鼻肠管进行定位的方法。方法:随机选择符合鼻肠管留置指征的危重症病人60例,采用床旁盲插法,置管过程中均常规采用传统气体灌注听诊法对鼻肠管进行初步定位,并记录结果。置管完成后,先通过超声扫查鼻肠管走行利用气体灌注法辅助定位,直至可疑头端位置,采用气体冲击灌注,若该处肠腔内出现瞬间气体强回声充盈,再将胃窗声学造影剂注入鼻肠管。若肠腔内出现造影剂充盈并清晰显示鼻肠管头端可予以明确。以胸腹部X线检查为判断鼻肠管定位的金标准,幽门后置管为置管成功的标准,将胃肠超声造影技术联合气体灌注法与传统气体灌注听诊法进行比较。比较两种方法进行鼻肠管定位的敏感性、特异性、阳性预测值、阴性预测值和准确度。结果:在60例行胃肠超声造影技术联合气体灌注法定位鼻肠管的病人中,定位成功58例(96.7%),其中56例位于幽门后,2例位于胃内,定位失败2例(3.3%),敏感性为96.6%,特异性为100%,阳性预测值为100%,阴性预测值为50%,准确度为96.7%。传统气体灌注听诊法的敏感性为74.1%,特异性为50%,阳性预测值为97.7%,阴性预测值为6.3%,准确度为73.3%。经统计学分析,除阳性预测值外,其余均高于传统气体灌注听诊法(P<0.05)。结论:胃肠超声造影技术联合气体灌注法具有较高的敏感性、特异性、阴性预测值和准确度,可成为一种准确、实时、便捷、安全的鼻肠管定位方法。

Objective： To evaluate the clinical application value of gastrointestinal contrast-en- hanced ultrasound combined gas injection method in verifying the location of nasointestinal tube in criti- cally ill patients. Methods ： Data of 60 critically ill patients who had the indications of indwelling naso- intestinal tube were collected from September 1,2015 to September 1,2016 in the Intensive Care Unit of Zhejiang Provincial People Hospital. The position of nasointestinal tube in patients who underwent bed- side blind insertion would be confirmed routinely through gas injection auscultation method. After tube was inserted, its route was scanned by ultrasound with gas perfusion assistance. Afterwards, rapid gas perfusion was used until suspicious tube end position was determined. Furthermore, oral ultrasound con- trast agent was injected into the tube if instantaneous strong echo of gas was observed in localized lumen, and contrast agent filling meant the placement being successful. Two methods of position confirmation ofnasointestinal tube in critically ill patients included gastrointestinal contrast enhanced ultrasound com- bined gas injection and gas injection auscultation only, and the effect of the two methods was compared and confirmed by chest and abdominal X ray examinations to verify the location of nasointestinal tube be- low pylorus. Results： A total of 60 patients were included in this study, 58 patients （96.7%）in gas- trointestinal contrast enhanced ultrasound combined gas injection group were successfully positioned. Among them, the placements of tube in 56 cases were below pylorus, while 2 cases were above pylorus. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of location of gastrointestinal contrast enhanced ultrasound combined gas injection method were 96.6%, 100%, 100%, 50%, 96.7% and of gas injection auscultation method were 74.1%, 50% ,97.7% ,6.3% and 73.3%. The differences of the sensitivity, specificity, negative predictive value and accuracy between the two methods were statistically significant （ P 〈 0.05 ）. Conclusion ： Gastrointestinal contrasten- hanced ultrasound combined gas injection method is a safe, simple and convenient method with high sen- sitivity, specificity, negative predictive value and accuracy in confirming the location of the nasointestinal tube.