摘要目的 改良床旁跨幽门螺旋型鼻肠管盲插方法,并评价其在重型急性胰腺炎(SAP)患者中的应用效果.方法 结合临床实践经验,将"四点测量法""四点听诊法"和"轻抖法"等技巧方法融于传统床旁跨幽门螺旋型鼻肠管盲插方法各环节,形成规范、操作性强、可考核的改良床旁跨幽门螺旋型鼻肠管盲插方法,并选取2016年11月1日—2018年3月31日在陆军军医大学附属新桥医院消化内科住院治疗的50例SAP患者为研究对象,初步评价改良置管方法的置管成功率、置管耗时、置管前后生命体征、置管相关并发症、患者满意度等指标.结果 改良床边盲插跨幽门鼻肠管方法在50例SAP患者中置管成功率为96%(48/50);置管耗时中位数22.8(10～60)min;置管前后患者的血压、心率、呼吸及血氧饱和度变化差异无统计学意义(P＞0.05);未发生心律失常、出血、穿孔、误入气道等置管相关并发症.患者对置管满意度100%(50/50).结论 改良的床旁跨幽门螺旋型鼻肠管盲插方法具有操作性强,易学易用的优势,在SAP患者中的初步应用具有较好效果,可在进一步采用论证强度更高的随机对照试验全面评价基础上,在临床重症患者中推广应用.

abstractsObjective To improve the method of bedside blind placement of bengmark nasointestinal tube, and evaluate its application effect in severe acute pancreatitis (SAP) patients. Methods Combined with clinical practice experience, the "four-point testing method" "four-point auscultation method" and "gently shaking method" were applied to the traditional blind placement, so as to form a standard, operative and highly-qualified blind placement method of the blind placement of the bengmark nasointestinal tube. A total of 50 SAP patients hospitalized in the Gastroenterology Department of Xinqiao Hospital Affiliated to Army Medical University from November 1st, 2016 to March 31st, 2018 were recruited to evaluate the catheterization success rate of the new catheterization method, time-consuming of catheterization, vital signs, catheter-related complications, patient satisfaction, and other indicators. Results The success rate of bedside blind placement of bengmark nasointestinal tube in 50 patients with SAP was 96% (48/50). The median catheterization time was 22.8 (minimum 10 to longest 60) min. There was no statistical significance in the differences of blood pressure, heart rate, respiration, and oxyhemoglobin saturation before and after catheterization (P＞ 0.05). No arrhythmia, bleeding, perforation, misplaced airways, and other related complications occurred. The satisfaction degree of catheterization was 100% (50/50). Conclusions The improved bedside blind placement of bengmark nasointestinal tube has the advantages of strong operability, easy to learn and use, and at the same time has good results in the preliminary application of SAP patients. It can be used in further randomized controlled trials with higher intensity of demonstration and can be used in severe patients.