摘要目的 比较超声引导下及胃镜引导下鼻肠管置入术在危重患者中的应用.方法 纳入95例拟行肠内营养(EN)的重症患者,采用随机对照法分为超声引导组(48例)和胃镜引导组(47例),比较不同分组的成功率,并发症的发生率及所花费时间.结果 超卢引导组成功率低于胃镜引导组(81.3％ vs 100％,P=0.003),主要为超声引导组前24例阶段置管成功率低(66.7％ vs 100％,P =0.000),后24例阶段成功率明显升高(95.8％vs 100％,P=0.338);胃镜引导组与超声引导组发生并发症差异无统计学意义(2.1％ vs 0,P=1.000),超声引导组花费时间更短[(13.3 ±2.8)min vs(15.0±1.4)min,P=0.000];超声引导组前24例与后24例相比,成功率较低(66.7％ vs 95.8％,P =0.023),花费时间更长[(15.4±2.1)min vs (11.2±1.4)min,P=0.000],并发症发生率增高,但差异无统计学意义(4.2％ vs 0,P=1.000);不同疾病组[重症胰腺炎(SAP)组vs脑血管病组]的置管成功率差异无统计学意义(94.9％ vs 87.5％,P=0.300),但SAP组耗时更短[(12.6±1.9)min vs(15.5±2.0)min,P=0.000].结论 超声引导下鼻肠管置入术是一种安全、方便快捷的肠内营养方法.

abstractsObjective To compare ultrasound-and endoscopy-guided methods in nasogastrojejunal tube placement in critical ill patients at bedside.Methods A tot al of 95 critical ill patients planed to perform enteral nutrition (EN) were enrolled.They were divided randomly into ultrasound-guided group (48 patients)and endoscopy-guided group (47 patients).The success rate,the incidence of complications and the time they took were compared between two groups.Results Ultrasound guided group was compared to endoscopy guided group with a lower success rate (81.3％ vs 100％,P =0.003),mainly because of the initial 24-stage having a very low success rate (66.7％ vs 100％,P =0.000),but the success rate of the following 24 cases was significantly improved (95.8％ vs 100％,P =0.338).Ultrasound guided group didn 't cause more complications (2.1％ vs 0,P =1.000),and consumed less time [(13.3 ± 2.8)min vs (15.0 ± 1.4) min,P =0.000].Compared to the following 24 cases,the initial 24 cases of ultrasound guided group in nasogastrojejunal tube placement had the lower success rate (66.7％ vs 95.8％,P =0.023),the longer time-consuming [(15.4 ±2.1)rin vs (11.2 ± 1.4) min,P =0.000],and but didnt cause more complications (4.2％ vs 0,P =1.000).The success rate of different diseases [severe acute pancreatitis(SAP) vs cerebrovascular disease] hadn't statistically significant difference (94.9％ vs 87.5 ％,P =0.300),but the SAP group consumed less time [(12.6 ± 1.9)min vs (15.5 ± 2.0)min,P =0.000].Conclusions The placement of nasogastrojejunal tube under ultrasound guidance represented a safe,quick and effective method to provide enteral nutrition.