超声引导鼻空肠管放置的临床价值

摘要

Objective To evaluate the application value of ultrasound guidance in nasogastrojejunal tube placement in critical ill patients at bedside. Methods Thirty - three critical ill patients planned to perform enteral nutrition were enrolled.After 1 h gastrointestinal decompression on an empty stomach, the nasogastrojejunal tube was inserted into the gastral cavity under ultrasound guidance, then 300 ～400 ml saline of 37℃ was injected into gastral cavity to form the acoustic window. The nasogastrojejunal tube was inserted into duodenum and jejunum combined with the gastrointestinal motility. The location of nasogastrojejunal tube was confirmed by plain abdominal radiography. Results The placements of nasogastrojejunal tube was successful in 31 patients, failed in 2 patients. The reason of failure was the lost gastrointestinal motility led to the sticking of nasogastrojejunal tuhe on arcus major ventriculi and it couldn't enter into gastricantrum, pylorus. Conclusion The placement of nasogastrojejunal tube under ultrasound guidance draws assistance from the formation of acoustic windows by saline, tracking metal guidewire by ultrasound, it is a new feeding technique, and it's convenient, accurate, and easy to operate, it has high application value in clinic.%目的 探讨超声引导下床旁鼻空肠管留置在危重患者肠内营养中应用价值.方法 33例拟行肠内营养的危重患者,置管前禁食、胃肠减压1 h、超声引导鼻空肠管进入胃腔内,注入预先加热至37 ℃的生理盐水300～400 ml,待形成声窗,在胃蠕动的配合下引导鼻空肠管推送入十二指肠,直至空肠,并床旁摄腹部平片确认位置.结果 成功引导31例,失败2例.失败原因是患者胃蠕动消失,鼻空肠管末端贴于胃大弯处,无法弯曲进入胃窦、幽门.结论 用生理盐水作胃声窗,金属导丝作追踪目标,床旁超声引导下鼻空肠管置入术是一种新的喂养管置入法,具有方便、准确、利于床旁操作等特点,有较好临床应用价值.