体表描绘法联合实时超声引导定位在神经重症患者鼻肠管置管中的应用

Application of surface marking to confirm the correct position of the nasojejunal tube in real-time ultrasonography in critical care patients

目的探讨提高神经重症患者鼻肠管置管成功率的简便、安全的置管方法。方法将115例需要留置鼻肠管的神经重症患者根据入院时间分为对照组66例,观察组49例。对照组在鼻肠管置管过程中实施超声引导计算幽门短轴鼻肠管截面数量定位法,观察组实施体表描绘法联合超声引导定位法。比较两组置管成功率、置管时间、鼻肠管定位效能、治疗费用及置管后并发症等指标。结果观察组总置管成功率97.96%,首次置管成功率87.76%,置管总次数(1.12±0.33)次,置管时间30(30,50)min;对照组总置管成功率86.36%,首次置管成功率62.12%,置管次数(1.38±0.63)次,置管耗时60(40,70)min。观察组显著优于对照组(均P<0.05)。观察组鼻肠管定位的特异度、灵敏度、阳性预测值、阴性预测值、准确度分别为83.33%、100.00%、97.73%、100.00%、97.96%,对照组分别为64.00%、92.68%、80.85%、84.21%、81.82%。观察组置管治疗总费用及消化道出血发生率显著低于对照组(均P<0.05)。结论体表描绘法联合实时超声引导定位可提高神经重症患者鼻肠管置管成功率,降低治疗费用,并具有较好的安全性。

Objective To explore a simple and safe method to enhance the success rate of nasojejunal tube placement in neurocritical care patients.Methods A total of 115 neurocritical care patients requiring nasojejunal tube placement were chronologically divided into two groups.During sonographic procedure,position of the tube in the control group(n=66)was confirmed using the standard short-axis ultrasonic view of the gastric pylorus and calculating the number of cross-sections of the tube,while that in the observation group(n=49)was confirmed by making surface marks from ultrasound images when the tube was visualized at some specific anatomical points.The success rate,placement time,efficacy of conforming tube positioning,treatment costs,and complications were compared between the two groups.Results The total success rate of tube placement in the observation group was 97.96%,with a first-attempt success rate of 87.76%,and the average number of placements was 1.12±0.33,with placement time of 30(30,50)min.Those in the control group were 86.36%,62.12%,1.38±0.63,and 60(40,70)min,respectively.The observation group showed significant improvements in the above-mentioned parameters compared to the control group(all P<0.05).The specificity,sensitivity,positive predictive value,negative predictive value,and accuracy in the observation group were 83.33%,100.00%,97.73%,100.00%,and 97.96%,respectively,while in the control group were 64.00%,92.68%,80.85%,84.21%,and 81.82%,respectively.The total treatment costs and the incidence of gastrointestinal bleeding in the observation group were significantly lower than those in the control group(both P<0.05).Conclusion Surface marking combined with real-time ultrasonography may confirm the correct positioning of nasojejunal tube in neurocritical care patients,resulting in reducing treatment costs and offering better safety.