经鼻留置胃管时不同体位胃管走行路径的影像分析

目的]分析经鼻留置胃管不同体位下胃管路径的影像变化，为改良经鼻留置胃管技术提供影像解剖依据。方法]26例需留置胃管的病人以垫肩颈仰头体位经鼻留置胃管后，分别取垫肩颈仰头体位及平卧位行CT扫描，通过多平面重组（MPR）及最大密度投影（MIP）等后处理观察胃管走行路径，在正中矢状位测量各观察指标。结果]垫肩颈仰头位时：鼻尖至食管入口连线长度（A1）（118．71±6．66）mm，寰椎前弓至A1的垂直距离（A2）（42．35±7．81）mm，颚骨上缘与第2颈椎椎体后缘的角度（A3）（91．17±7．90）。及颚骨上缘与第5颈椎椎体后缘的角度（A4）（97．99±8．79）。；平卧位时：A1为（114．58±9．07）mm，A2为（38．72±7．44）mm，A3为（95．15±8．78）。，A4为（94．42±10．58）°。结论]垫肩颈仰头仰卧位留置胃管技术具有明显的解剖学优势，使胃管走行曲度变大，更有利于临床置管并减轻病人副反应。关键词：留置胃管；计算机断层成像；垫肩颈仰头体位；

Analysis on image of tube traveling path in different postures when nasal gastric tube indwelling

Objective. To analyze and compare the imaging changes of gastric tube path under different positions of nasal gastric tube indwelling, so as to provide imaging and anatomy evidences for improving nasal gastric tube technology. Methods. A total of 26 cases of patients who need indwelling gastric tube were selected, and they were examined by CT respectively with shoulder and pillow pad upward position and supine after the nasalgastric tube indwelling in shoulder pads neck upward position. The gastric tube traveling path was observed after MIP and MPR treatment and all indicators were measured in the median sagittal plane. Results. Shoulder and pillow pad upward position A1 （118.71±6.66） mm, Supine A2 （42.35± 7.81） mm; shoulder and pillow pad upward position A3（91. 17±7.90）; shoulder and pillow pad upward position A4 （97.99 ±8.79） ; Supine position： A1 was （114. 58±9. 07） mm,A2 was （38. 72±7.44） mm,A3 was （95. 15=k8. 78）°, A4 was （94. 42±10. 58） o. Conclusion. Gastric tube technology in shoulder pads neck upward in a supine position has obvious anatomical advantages, so that the curvature of gastric tube traveling is larger, and it is more conducive to clinical catheterization and reduce the side effects of patients.