胃幽门超声短轴切面内鼻肠管截面计数法定位重症病人留置鼻肠管的价值

The value of section counting method in the short-axis ultrasonic view of the gastric pylorus in positioning the naso-intestinal tube in critically ill patients

目的:探讨胃幽门超声短轴切面内鼻肠管截面计数应用于定位重症病人留置鼻肠管的价值。方法:选择2019年5月1日至2020年7月1日浙江省人民医院重症医学科符合鼻肠管置管指征的重症病人157例,行盲插置管术。置管完成后,通过超声检查,获得胃幽门部的短轴标准切面,观察其内特征性的鼻肠管短轴截面声像并计数,必要时向管腔内注水或注气进行增强显像。将计数结果进行分组(奇数组,偶数组),分别进行定位效能分析,并记录超声检查时间及相关并发症。以腹部X线作为鼻肠管定位金标准。定位结果一致表示超声定位成功。结果:154例(98.1%)通过超声检查可快速显示胃幽门超声短轴切面及鼻肠管截面,中位检查时间为5(5-10)秒。139例(139/154,90.3%)在胃幽门超声短轴切面中发现的鼻肠管截面数为奇数(1或3),其中132例(95.0%)确定为幽门后置管,其定位幽门后置管的敏感度,特异度,阳性预测值,阴性预测值和准确性分别为97.8%,75.0%,99.2%,50.0%和97.1%。15例(15/154,9.7%)在胃幽门超声短轴切面中发现的鼻肠管截面数为偶数(0或2),其中13例(86.7%)为幽门前置管,其定位幽门前置管的敏感度,特异度,阳性预测值,阴性预测值和准确性分别为92.9%,0.0%,92.9%,0.0%,和86.7%。结论:胃幽门部及鼻肠管短轴截面通过超声检查易于探及;胃幽门超声短轴切面内鼻肠管截面计数法应用于鼻肠管定位具有较高的效能,有助于构建系统化、标准化鼻肠管超声定位流程。

Objective: To evaluate the value of section counting method in the short-axis ultrasonic view of the gastric pylorus in positioning the naso-intestinal tube in critically ill patients. Methods: A total of 157 critically ill patients hospitalized in the intensive care unit(ICU)of Zhejiang Provincial People’s Hospital, who were eligible for nasointestinal tube placement, were selected for unmonitored tube insertion, from May 1, 2019, to July 1, 2020. After tube placement, the standard short-axis ultrasonic view of the gastric pylorus was obtained, and cross-sections of the nasointestinal tube were observed and counted. If necessary, water or air was injected into the tube cavity for enhanced imaging. According to the count results, the patients were divided into two groups, odd group and even group to analyze the positioning performance, and record the ultrasound examination time and related complications. The results were compared with the abdominal X examination,which was considered as the gold standard for tube positioning. Consistent results indicated a successful ultrasound positioning. Results: The short-axis ultrasonic view of the pylorus and crosssection of the nasointestinal tube was rapidly observed in 154 cases(98.1%), time-consuming(median duration)5 [5 - 10]s.The number of cross-sections of the tube was found as an odd number(1 or 3) in 139 cases(139/154, 90.3%), of which132 cases(95.0%) were identified as post-pyloric tubes. The performance indicators for post-pyloric tube were 97.8%,75.0%,99.2%,50.0%, and 97.1%, for sensitivity, specificity, positive predictive value, negative predictive value, and accuracy, respectively. The number was found as an even number(0 or 2) in 15 cases(15/154, 9.7%), of which 13 cases(86.7%) were identified as anterior pyloric tubes. The performance indicators for post-pyloric NIT positioning were92.9%, 0.0%, 92.9%, 0.0%, and 86.7%, for sensitivity, specificity, positive predictive value, negative predictive value,and accuracy, respectively. Conclusion: The gastric pylorus and the cross-section of the nasointestinal tube can be easily detected by ultrasound. The counting method of the number of cross-sections of the tube in the short-axis ultrasonic view of the pylorus is highly effective in the positioning of the nasointestinal tube, which is helpful to construct a systemic and standardized ultrasound positioning protocol for the nasointestinal tube.