摘要目的 初步探讨以肠内营养混悬液为混合介质的超声造影剂在重症患者留置鼻肠管定位中的价值.方法 选取2018年6月1日至2019年4月1日浙江省人民医院重症医学科已留置鼻肠管的重症患者45例,其中男30例,女15例,平均年龄为(63±17)岁.选取肠内营养混悬液百普力作为研究介质,前期通过体内外实验明确其超声显像性能;通过体外实验明确微泡超声造影剂与百普力的最佳混合配制比例,静置并动态观察其稳定性.利用常规超声明确鼻肠管位于消化道内,开启超声造影模式,将以百普力为混合介质的超声造影剂注入鼻肠管,实时观察并记录鼻肠管走行及头端位置.以腹部X线或CT检查结果作为“金标准”对超声定位结果进行判定,结果一致者代表定位成功.结果 体内外实验显示百普力具有良好的超声显像均匀度及穿透力,可清晰显示充盈肠段的范围及边界;体外实验显示微泡超声造影剂与百普力按1∶1000与1∶500比例配制成的造影剂显影效果最佳,静置10 min以内具有最佳的分布均匀度及稳定性.45例患者中应用超声造影剂成功定位鼻肠管43例(95.6％),一次即成功定位39例,所需时间为(1.6±0.5) min,需多次超声造影定位成功4例,所需时间分别为(5.1±0.5)min,其中1例为胃内折曲,1例于十二指肠降部折曲回胃内.2例(4.4％)定位失败.所有患者检查过程中均未出现明显并发症.结论 以肠内营养混悬液为混合介质的超声造影剂兼具营养液与微泡超声造影剂的优势,可便捷、安全、有效显像及定位重症患者留置鼻肠管的走行及头端.

abstractsObjective To evaluate the value of ultrasound contrast agent with enteral nutrition suspension as mixed medium in locating indwelling nasointestinal tube in critically ill patients.Methods Total of 45 critically ill patients had nasointestinal tube indwelled were collected from June 1,2018 to April 1,2019 in the Intensive Care Unit of Zhejiang Provincial People's Hospital,including 30 males and 15 females,with an average age of (63± 17) years.Enteral nutritional suspension Peptisorb Liquid was used as research medium,with the ultrasonic imaging performance of it confirmed by in vitro and in vivo experiments.The optimal mixing ratio of microbubble ultrasound contrast agent and Peptisorb Liquid was confirmed by in vitro experiment,then the mixture was quietly placed and its stability was dynamically observed.The nasointestinal tube was confirmed in the digestive tract by conventional ultrasound and then the ultrasound contrast mode turned on.Ultrasound contrast agent with Peptisorb Liquid as mixed medium was injected into the nasointestinal tube and the tube direction and end position were observed and recorded in real time.Abdominal X-ray examination or CT was used as the gold standard for verifying the location of the nasointestinal tube and the same result represented successful positioning.Results The in vitro and in vivo experiments showed that Peptisorb Liquid had good ultrasound imaging uniformity and penetrating power,which could clearly show the range and boundary of the filling intestine cavity;the in vitro experiment showed that the ultrasound contrast agent prepared with the microbubble ultrasound contrast agent and Peptisorb Liquid by the ratio of 1 ∶ 1 000 and 1 ∶ 500 which had the best imaging effect and the best distribution uniformity,with the best stability within 10 minutes after quietly placed.Nasointestinal tubes were successfully located by using ultrasound contrast agent with enteral nutritional suspension as mixed medium in 95.6％(43/45) of the patients collected in this study,including success at one attempt in 39 cases,the operating time was (1.6±0.5) minutes and 4 cases were successfully located after multiple operations with (5.1 ±0.5) minutes,the tube bent in the stomach in one case and flexed back into the stomach from the descending duodenum in another.The operation failed in 2 cases (4.4％).No significant complications occurred during the examination.Conclusion The ultrasound contrast agent with enteral nutritional suspension as mixed medium has the advantages of both,which can conveniently,safely and effectively locate the direction and end position of nasointestinal tube in critically ill patients.