四点听诊导航法徒手盲插鼻肠管在危重患者中的应用

The application of four-point auscultation navigation method of unequipped blind insertion of naso-intestinal feeding tube in critically ill patients

目的探讨四点听诊导航法在危重患者床旁徒手盲插鼻肠管中的应用效果,为危重患者寻找一种简便快捷、安全有效、成功率高的徒手盲插鼻肠管的方法。方法观察临床需要留置鼻肠管的患者41例,采用四点听诊导航法,即先将导管置入胃内,彻底排空胃内容物包括气体,在继续送管的过程中,顺序听诊剑突下、左肋下、脐上、右肋下四个部位,分别对应胃贲门部、胃底部、胃体部和胃幽门部。听诊四个部位的气流声并进行对比,声音最响亮的部位为导管尖端的部位,以此判断导航导管尖端走行。结果 41例置管,平均用时28.78±9.77 min,成功率92.7%。而且患者是否气管插管和置管前给予促胃肠动力药与不给药对置管成功率无影响。无严重并发症发生。结论四点听诊导航法盲插鼻肠管操作简单用时少,成功率高,不受气管插管影响,无需额外药物辅助,值得在临床推广使用。

Objective To explore the application effect of four auscultation navigation methods in the bedside insertion of naso-intestinal feeding tube for critically ill patients,in order to find a simple,quick,safe and effective method.Methods 41 cases of clinical patients with indwelling nasal intestine were observed and treated by four-point auscultation navigation method:Insert catheter into the stomach and completely empty the gas-included gastric contents.As tube feeding continues,auscultating the below xiphoid,left subcostal,above umbilical and right subcostal,corresponding to the stomachus cardiacus,gastric fundus,gastric body and stomachus pylorus respectively.The sound of the four parts were compared.The loudest one was the tip of the catheter,which navigated the routes.Results In 41 tube feeding cases,the average performance time was 28.78±9.77 minutes and the success rate was 92.7%.There was no effect on the success rate of whether endotracheal intubation or gastrointestinal motility drugs were given.No serious complications occurred.Conclusion Four-point auscultation navigation method of naso-intestinal feeding tube is easy to operate,with less time consumption and high success rate.It is neither affected by endotracheal intubation nor additional drug assistance,which makes the method worthy of clinical application.