床边判断重症患者盲插鼻肠管尖端通过幽门方法的研究

目的：研究重症患者盲插螺旋形鼻肠管判断导管尖端通过幽门的方法。方法回顾性分析某院重症医学科2011年5月至2012年12月176例盲插螺旋形鼻肠管重症患者，在置管过程中，通过床边综合判断方法(注气听诊法联合胃液或小肠液 pH 测试法)初步确定导管尖端通过幽门在肠道，最后经 X 线证实，验证该方法的准确性。结果对于176例盲插螺旋形鼻肠管患者，床边综合判断方法鼻肠管位置通过幽门成功率89.20%(157例)，失败率10.80%(19例)；其中成功的157例中有117例(74.54%)通过肠内肠液监测 pH 值碱性；40例(25.48%)患者肠内未抽出肠液。结论通过床边综合判断方法判断导管尖端通过幽门的准确率高，操作简便易行，避免了反复 X 线照射等对于患者射线吸收及经济负担等不利影响，对临床判断盲插鼻肠管效果具有重要意义。

Study on blind insertion nasointestinal tube tip through the pylorus of severe patients

Objective To study the method of blind insertion nasointestinal tube tip through the pylorus.Methods Retro-spective analysis 1 76 critical patients who received blind insertionspiral nasointestinal tube in intensive care unit from 201 1 May to 2012 December.In the process of inserting tubes,Preliminary determined the tip through the pylorus by the comprehensive judgement methods including auscultation after gas injection,gastric orintestinal fluid pH test,finally confirmed by X-ray,and judged the accuracy of the method.Results For the 1 76 patients with spiral nasointestinal tube by blind insertion,the accuracy rate of bedside comprehensive method to judge the nasointestinal tube position through the pylorus was 89.20% (1 57),and the failure rate was 10.80% (1 9);Among the 1 57 cases,the succus entericus pH value of 1 1 7 cases (74.54%)wsa alkaline;40 pa-tients(25.48%)did not extract succus entericus.Conclusions the accuracy of bedside comprehensive method by the ausculta-tion of the abdomen and gastric orintestinal fluid pH value to determine nasointestinal tube tip through the pylorus is high,and the operation is simple and convenient.It has an important significance for clinical judgment the effect of blind insertion nasoin-testinal tube.