超声定位联合渐进式注水法在老年重症患者鼻肠管置管中的应用

目的探讨超声定位联合渐进式注水法在老年重症患者鼻肠管置管中的应用价值。 方法选择2018年1至10月在浙江医院重症医学科行经鼻肠管肠内营养支持的老年重症患者52例为研究对象。置管过程中使用床旁超声联合渐进式注水法引导鼻肠管置入，并在不同解剖位置定位鼻肠管头端。以腹部X线检查确认鼻肠管头端位于幽门后作为成功置管的标准。计算置管成功率，超声定位法的敏感度、特异度、阳性预测值、阴性预测值及准确性。 结果52例老年重症患者中48例（92.3%）置管成功，其中46例（88.5%）一次性置管成功，平均置管时间为（21.0±4.7）min；4例（7.7%）置管失败，经腹部X线确认均为胃内打折。48例置管成功患者中有46例使用超声定位成功，2例幽门后未探及鼻肠管声影。超声定位法的敏感度、特异度、阳性预测值、阴性预测值和准确性分别为95.8%、100.0%、100.0%、67.0%、96.2%。 结论超声定位联合渐进式注水法能快速、准确、安全地引导老年重症患者鼻肠管置入，具有较好的临床应用价值。

Application of ultrasound localization combined with water injection in nasointestinal tube placement in elderly patients with severe diseases

ObjectiveTo explore the value of ultrasound localization combined with water injection in nasointestinal intubation in elderly patients with severe diseases. MethodsA total of 52 elderly critically ill patients admitted to Zhejiang Hospital from January 2018 to October 2018 who underwent enteral nutrition support were selected as subjects. Ultrasound-guided water injection is used to guide the placement of the nasointestinal tube. Ultrasound positioning of the nasointestinal tube at different anatomical locations was performed during catheterization. When abdominal X-ray examination confirmed that the head of naso intestinal tube was located behind the pylorus, the catheterization was successful. Calculate the success rate of catheterization, sensitivity, specificity, positive predictive value, negative predictive value and accuracy of ultrasonic localization. ResultsAmong the 52 elderly patients, 48 cases were successfully catheterized, and the success rate was 92.3%. Among them, 46 cases (88.5%) had successful one-time tube placement, and the average tube placement time was (21.0±4.7) min. Four cases (7.7%) failed to place the tube, and the abdominal X-ray examination confirmed the tube was folded in stomach. The 48 elderly patients who underwent successful catheterization, 46 were successfully located with ultrasound, and the nasointestinal tube was not located at pylorus in 2 cases. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the ultrasonic localization method were 95.8%, 100.0%, 100.0%, 67.0%, and 96.2%, respectively. ConclusionUltrasound localization combined with water injection can quickly, accurately and safely guide the nasointestinal tube placement in elderly critically ill patients.