床旁超声引导下徒手留置鼻空肠管在ICU机械通气患者的临床应用

目的 探讨超声引导下留置鼻空肠管置管技术在重症监护病房机械通气患者中的应用,为早期建立幽门后肠内营养提供新的有效途径。方法 选择2018 年1 月～2019 年12 月重症医学科收治的机械通气患者200 例,在床旁超声引导下留置鼻空肠管,在导管插入过程中通过超声快速探查并找到十二指肠,将超声结果与腹部X 线进行比较,以验证该方法的准确性,同时记录耗时和相关的并发症发生情况。结果 在200 例机械通气患者中,158 例患者首次超声检查十二指肠球部内鼻空肠管声像显示置管成功;30 例患者再通后,第二次超声检查显示置管成功;12 例患者因上腹部气体或十二指肠球囊部气体干扰,应用胃肠减压或胃肠动力药物后,成功置管5 例。成功定位十二指肠球囊超声显示率为96.5%（193/200）,最短时间为15 s,最长时间为246 s。所有患者在鼻空肠管放置和超声定位过程中均无明显并发症。结论 超声引导下留置鼻空肠管对ICU 机械通气患者的治疗具有重要价值,超声定位可以快速确定鼻空肠管是否已成功实现幽门后放置,安全、简单、准确度高,值得临床应用。

Clinical application of indwelling nasal jejunal tube under bedside ultrasound guidance in mechanically ventilated patients in ICU

Objective To explore the application of ultrasound-guided indwelling naso-intestinal tube in mechanically ventilated patients in intensive care units,and to provide a new and effective way for the early ultrasound guidance,and the duodenum was quickly explored and found by ultrasound during catheterization.The ultrasound results were compared with abdominal X-rays to verify the accuracy of the method.while recording time-consuming and related complications.The time and related complications were recorded.Results Among the 200 mechanically ventilated patients,158 patients in the first ultrasound examination for duodenal bulb nasal jejunal tube sound image showed successfully placed catheters.The second ultrasound examination showed successfully placed catheters after recanalizing in 30 patients.12 patients had gas interference in upper abdomen or duodenal balloon.After gastrointestinal decompression or application of gastrointestinal motility drugs,5 cases were successfully placed.193 cases(96.5%) had successful positioning of the duodenal balloon ultrasound,with the shortest time of 15 s,and the longest time of 246 s.All patients had no obvious complications during the process of indwelling nasal jejunal tube and ultrasound positioning.Conclusion Indwelling gastrointestinal tube under ultrasound guidance is of great value for the treatment of mechanically ventilated patients in ICU.Ultrasound positioning can quickly determine whether the nasointestinal tube has been successfully placed behind the pylorus.It is safe,simple,and highly accurate,and is worthy of clinical application.