摘要
目的:探讨使用床旁超声两步法判断鼻胃管位置在ICU病人中的应用价值。方法:收集2019年12月至2020年12月收住黄河三门峡医院ICU留置鼻胃管的病人64例,留置胃管后由床旁超声医师使用两步法,即通过床旁超声判断鼻胃管置入食管内、鼻胃管置入胃内、最后确定胃管位置,再由一名医师使用常规听诊法、气泡法判断胃管位置。判断完成后使用床旁X线作为金标准检验两种方法的准确性。结果:床旁X线最终确认胃管置于胃内59例(92.19%),异位5例(7.81%)。床旁超声两步法灵敏度98.31%(58/59),特异度80.00%(4/5),阳性预测价值98.31%(58/59),阴性预测价值80.00%(4/5),准确度96.88%(62/64)。常规法灵敏度92.31%(48/52),特异度58.33%(7/12),阳性预测价值90.57%(48/53),阴性预测价值63.64%(7/11),准确度85.94%(55/64)。以床旁超声两步法和常规判断作为检验变量,X线检查作为状态变量,绘制ROC受试者工作曲线,显示超声判断胃管位置的ROC曲线下面积为0.990,P<0.05。常规判断胃管位置的ROC曲线下面积为0.775,P>0.05。结论:床旁超声两步法判断鼻胃管位置与传统听诊法、气泡法相比,具有较高的灵敏度,阳性预测价值,且方法简单、有效、可重复、快捷、无辐射。
Objective:To explore the application value of bedside ultrasound two-step method to help determine the position of nasogastric tube in critically ill patients.Methods:A total of 64 patients admitted to the ICU of the Yellow River Sanmenxia Hospital who had nasogastric tube from December 2018 to December 2019 were included.After the gastric tube placement,physician used a bedside ultrasound two-step method to determine whether the nasogastric tube was placed in the esophagus,or in the stomach,and finally the position of the gastric tube was determined,Then another physician used conventional auscultation and bubble methods to determine the position of the gastric tube.After the determination was completed,the accuracy of the two methods was compared by using the bedside X-ray as the gold standard.Results:In the bedside X-ray examination,59 cases(92.19%)of gastric tubes were confirmed and 5 cases(7.81%)were ectopically placed.Bedside ultrasound two-step method had a sensitivity of 98.31%(58/59),a specificity of 80.00%(4/5),a positive predictive value of 98.31%(58/59),a negative predictive value of80.00%(4/5),and an accuracy of 96.88%(62/64).The conventional method had a sensitivity of 92.31%(48/52),a specificity of 58.33%(7/12),a positive predictive value of 90.57%(48/53),a negative predictive value of 63.64%(7/11),and an accuracy of 85.94%(55/64).Taking bedside ultrasound two-step method and routine judgment as test variables,and X-ray examination as state variables,ROC curve was drawn.The area under ROC curve of ultrasonic judgment of gastric tube position was 0.990,P<0.05.The area under ROC curve was 0.775 for the conventional method,P>0.05.Conclusion:Compared with the traditional auscultation and bubble method,the bedside ultrasound two-step method for determining the position of the nasogastric tube had a higher sensitivity and positive predictive value.The method is simple,effective,reproducible,fast and free of radiation.
作者
兀瑞俭
詹晓娟
王茹茹
郭发瑞
柴晓波
WU Riu-jian;ZHAN Xiao-juan;WANG Ru-ru;GUO Fa-rui;CHAI Xiao-bo(Department of critical medicine,Yellow River Sanmenxia hospital,Sanmenxia 472000,Henan,China)
出处
《肠外与肠内营养》
CAS
CSCD
北大核心
2021年第6期357-361,共5页
Parenteral & Enteral Nutrition
关键词
鼻胃管
床旁超声
肠内营养
ICU
Nasogastric tube placement
Bedside ultrasound
Enteral nutrition
ICU
