【摘要】：目的： 評估應(yīng)用床旁超聲協(xié)助確定嚴(yán)重創(chuàng)傷患者鼻飼管位置的價(jià)值,為鼻飼管的定位提供一種快速有效的新方法。 方法： 為前瞻性對照觀察研究。研究對象為2011年10月至2012年3月一家大學(xué)附屬的三級甲等綜合性醫(yī)院急診ICU內(nèi)符合指征的115例嚴(yán)重創(chuàng)傷患者,以床旁盲插法置入鼻飼管,應(yīng)用床旁超聲在不同部位(頸部、食道下端-賁門、胃體)探查鼻飼管進(jìn)行定位,并與常規(guī)定位法(聽診法、抽吸液觀察法)比較,以X線攝片為金標(biāo)準(zhǔn),評價(jià)不同定位方法的效能。應(yīng)用SPSS13.0統(tǒng)計(jì)軟件包(SPSS公司,美國),計(jì)算常規(guī)法(聽診法和抽吸觀察法)、床旁頸部超聲定位法、腹部超聲(包括食道-賁門定位法和胃體定位法)行鼻飼管定位的敏感性、特異性、陽性預(yù)測值、陰性預(yù)測值和準(zhǔn)確度,結(jié)果以計(jì)數(shù)或率表示。將不同超聲定位方法和常規(guī)聽診法、抽吸觀察法進(jìn)行敏感性、特異性、陽性預(yù)測值、陰性預(yù)測值和準(zhǔn)確度的比較,對超聲三種檢查方法敏感性、特異性、陽性預(yù)測值、陰性預(yù)測值和準(zhǔn)確度進(jìn)行比較(四格表卡方檢驗(yàn)),以P0.05為差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果： 1)115例患者經(jīng)X線攝片確認(rèn)鼻飼管異位7例(異位率6%),其中氣管內(nèi)異位3例、食道內(nèi)返折4例。 2)聽診法和抽吸液觀察法的敏感性(分別為79.6%,73.1%)、特異性(28.6%,71.4%)均較低,準(zhǔn)確率為76.5%、73.0%。 3)超聲頸部定位法的敏感性(100%)和準(zhǔn)確性(96.5%)最高,陰性預(yù)測值達(dá)100%,但特異性(42.9%)低。 4)超聲食道-賁門定位法的敏感性(88.9%)和準(zhǔn)確率(89.6%)較高,但陰性預(yù)測值為36.8%低于超聲頸部定位法,特異性達(dá)100%。 5)超聲頸部聯(lián)合食道-賁門內(nèi)鼻飼管定位法敏感性88.9%,特異性42.9%,陽性預(yù)測值和陰性預(yù)測值均為100%,準(zhǔn)確率達(dá)86.1%。 結(jié)論： 應(yīng)用床旁超聲確定嚴(yán)重創(chuàng)傷患者的鼻飼管位置較傳統(tǒng)定位法具有更高的敏感性和準(zhǔn)確性,其中頸部聯(lián)合食道-賁門超聲定位可進(jìn)一步提高特異性；而且超聲定位法簡單、快速、無輻射,值得進(jìn)一步研究和推廣
[Abstract]:Objective: to evaluate the value of bedside ultrasound in determining the location of nasogastric feeding tube in patients with severe trauma, and to provide a new rapid and effective method for the location of nasogastric tube. Methods: a prospective controlled study was conducted. From October 2011 to March 2012, 115 patients with severe trauma in emergency ICU of Grade 3A General Hospital affiliated to a university were placed in nasogastric tube with bedside blind insertion, and bedside ultrasound was used in different areas (neck, neck and neck). The lower end of esophagus-cardia and body of stomach) were used to locate the nasal feeding tube, and compared with the conventional localization method (auscultation, aspiration observation), the effectiveness of different localization methods was evaluated by using X-ray film as the gold standard. SPSS 13.0 statistical software package (SPSS, USA) was used to calculate the sensitivity of nasogastric tube localization by routine methods (auscultation and aspiration observation), bedside cervical ultrasound localization, abdominal ultrasound (including esophagal-cardia localization and gastric body localization). Specificity, positive predictive value, negative predictive value, and accuracy, the result is expressed as a count or rate. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of different ultrasonic localization methods and routine auscultation methods were compared, and the sensitivity, specificity and positive predictive value of three ultrasonic examination methods were compared. Negative predictive value and accuracy were compared (four square test), with P0.05 as the difference was statistically significant. Results: 1) among 115 patients, 7 cases (6%) were diagnosed as ectopic by nasogastric tube, among which 3 cases were ectopic in trachea, 3 cases were ectopic in trachea, and 3 cases were ectopic in trachea. The sensitivity and specificity of auscultation and aspiration fluid observation were 79.631% and 71.4%, respectively. The accuracy rate was 76.575% and 73.0%, respectively. The sensitivity (100%) and accuracy (96.5%) of ultrasonic cervical localization were the highest. The negative predictive value was 100, but the specificity (42.9%) was low. 4) the sensitivity (88.9%) and accuracy (89.6%) of ultrasound esophagal-cardiac localization were higher, but the negative predictive value of 36.8% was lower than that of cervical localization. The specificity was 100. 5) the sensitivity of ultrasonography combined with esophagal-cardiac nasogastric tube localization was 88.9 and the specificity was 42.9. The positive predictive value and negative predictive value were 100 and the accuracy was 86.1%. Conclusion: bedside ultrasound is more sensitive and accurate in determining the position of nasogastric tube in patients with severe trauma than the traditional localization method. Moreover, ultrasonic localization method is simple, rapid and radiation-free, which is worthy of further study and popularization.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R641

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本文編號：2130551