Harrison A M, Clay B, Grant M J, Sanders S V, Webster H F, Reading J C, Dean J M, Witte M K
Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, USA.
Crit Care Med. 1997 Dec;25(12):2055-9. doi: 10.1097/00003246-199712000-00026.
To determine whether a clinical, nonradiographic criterion can be used to predict when the tip of a blindly placed feeding tube is in the small intestine.
Prospective sample.
Pediatric intensive care unit at a tertiary care children's hospital.
Critically ill children requiring transpyloric feeding.
The small bowel was intubated, using a blind, bedside transpyloric feeding tube placement protocol. The feeding tube was considered to be in the small bowel when <2 mL of a 10- mL aliquot of insufflated air could be aspirated from the feeding tube. This clinical criterion was confirmed with an abdominal radiograph.
Patient age ranged from 1 month to 19 yrs (median 6 months). Weight ranged from 2.2 to 60 kg (median 4.9). Median time to feeding tube placement was 10 mins (range 5 to 60). Eighty-nine percent of the patients were mechanically ventilated, while 28% of these patients were pharmacologically paralyzed. Seventy-five feeding tubes were inserted. There were no known complications. Ninety-nine (74/75) percent of the feeding tubes were positioned in the small bowel. The inability to aspirate insufflated air correctly predicted small bowel intubation with 99% certainty (Sequential Probability Ratio Test, p = .05 and power = .80). This test incorrectly predicted the position of only one feeding tube, the 26th, which was in the stomach. Of the 74 feeding tubes positioned in the small bowel, 13 feeding tubes were in the duodenum and 61 were in the jejunum.
The inability to aspirate insufflated air confirms the transpyloric position of a feeding tube. Other clinical criteria did not successfully predict small bowel intubation. Use of this single test may obviate confirmatory abdominal radiographs in carefully selected patients and may lead to more cost-effective and timely initiation of enteral feedings.
确定一种临床而非影像学标准能否用于预测盲插饲管尖端何时位于小肠内。
前瞻性样本。
一家三级儿童专科医院的儿科重症监护病房。
需要经幽门喂养的危重症儿童。
采用盲法床边经幽门饲管放置方案对小肠进行插管。当从饲管中能抽出的注入空气量小于10毫升等分试样中的2毫升时，饲管被认为位于小肠内。此临床标准通过腹部X光片得以证实。
患者年龄从1个月至19岁（中位数为6个月）。体重从2.2千克至60千克（中位数为4.9千克）。放置饲管的中位时间为10分钟（范围为5至60分钟）。89%的患者接受机械通气，其中28%的患者使用了药物性麻痹。共插入75根饲管。未出现已知并发症。99%（74/75）的饲管位于小肠内。无法抽出注入空气能以99%的确定性正确预测小肠插管情况（序贯概率比检验，p = 0.05，效能 = 0.80）。该检验仅错误预测了第26根饲管的位置，其实际位于胃内。在位于小肠内的74根饲管中，13根在十二指肠，61根在空肠。
无法抽出注入空气可证实饲管的经幽门位置。其他临床标准未能成功预测小肠插管情况。在精心挑选的患者中使用这一单一检验可能无需进行腹部X光片确认，且可能使肠内喂养的启动更具成本效益且更及时。
