简化床旁超声法在重症患者鼻肠管定位中的应用价值

Simplified bedside ultrasound method in confirming the correct location of nasointestinal tube in critically ill patients

目的探讨简化床旁超声法在重症患者鼻肠管定位的应用价值。方法选择2016年3月至2017年4月台州市立医院重症医学科收治的需留置鼻肠管的患者59例。应用简化床旁超声法定位鼻肠管。超声探及幽门管处鼻肠管声影,且鼻肠管插入长度符合鼻尖至空肠的预计距离,则认为鼻肠管进入空肠。鼻肠管放置结束后,立即进行床旁超声检查及床旁腹部X线检查。以腹部X线检查结果作为验证鼻肠管头端位置的"金标准",计算简化床旁超声法鼻肠管定位的敏感度、特异度、准确性、阳性预测值、阴性预测值。采用Kappa分析分析简化床旁超声法与腹部X线检查对重症患者鼻肠管定位的一致性。结果简化床旁超声法判定鼻肠管进入空肠50例,腹部X线检查验证49例空肠在位;简化床旁超声法判定鼻肠管未进入空肠9例,腹部X线检查验证4例空肠在位。以腹部X线检查结果作为验证鼻肠管头端位置的"金标准",简化床旁超声法鼻肠管定位的敏感度、特异度、准确性、阳性预测值、阴性预测值分别为92.45%、83.33%、89.83%、98.00%、44.44%。Kappa分析结果显示,简化床旁超声法与腹部X线检查对重症患者鼻肠管定位的一致性Kappa=0.620。结论简化床旁超声法可以定位鼻肠管,其准确程度高,简单易学,快速方便,具有较好的临床应用价值。

Objective To evaluate the practicability of simplified bedside ultrasound method in confirming the correct placement of nasointestinal tube in critically ill patients.Methods Totally 59 critically ill patients who had nasointestinal tube indwelled were collected from March,2016 to April,2017 in Intensive Care Unit of Taizhou municipal Hospital.In these patients,the location of nasointestinal tubes were detected by using simplified bedside ultrasound method.The nasointestinal tube was confirmed in jejunum if acoustic shadow of nasointestinal tube was detected in canales pyloricus and the insertion length of the nasointestinal tube conformed to the estimated distance from the tip of the nose to the jejunum.Radiographic testing was applied as golden standard for judging naso-jejunal location.Then the accuracy,sensitivity,specificity and consistency with radiographic testing were calculated.Results Simplified bedsode ultrasound method showed that 50 patients had tubes in position,and 49 of them were confirmed in position by radiographic testing.This method showed that 9 patients did not have tubes in position,while 4 of them were confirmed in position by radiographic testing.Thus,the accuracy,sensitivity and specificity of simplified bedside ultrasound method in judging positions of nasointestinal tubes was 89.83%(53/59),92.45%(49/53),and 83.33%(5/6).The results of analysis showed that simplified bedside ultrasound and abdominal X-ray examination showed a general consistency in nasointestinal tube localization in severe patients(Kappa=0.620,P<0.001).Conclusions Simplified bedside ultrasound method can confirm naso-jejunal tube position in critically ill patients.This method is accurate,easy to learn,and can be detected quickly and conveniently.Simplified bedside ultrasound method has favorable clinical application value.