摘要：目的：探讨床旁超声直接扫查联合注水法在神经内科重症患者鼻肠管定位中的应用价值。方法： 选取2019年8月1日至11月30日内蒙古医科大学附属医院神经内科住院，符合鼻肠管留置的重症患者50例。鼻肠管置入术后，利用听诊法+抽液观察法判定鼻肠管头端位置；再采用床旁超声直接扫查联合注水法确定，具体步骤如下：①直接依次探查颈段食管、幽门孔、十二指肠水平部，观察并记录鼻肠管位置，如果能观察到鼻肠管通过幽门孔或位于十二指肠水平部，为置管成功；②经此步骤未能确定鼻肠管头端位置，则采用注水法：探头首先定位到十二指肠水平部，自鼻肠管快速注入30ml温生理盐水，见到十二指肠内液体迅速增多并或见液体翻滚征，则判定鼻肠管头端位于幽门后，为置管成功；③如未能确定则探头定位至胃腔，继续注入100~200ml生理盐水，胃内见到液体翻滚征或胃内液体明显增则判定头端位于幽门前，判定为异位，则置管失败。以腹部X线为金标准，成功标准为幽门后置管，统计50例患者床旁超声定位的成功率，与听诊法+抽液观察法比较二者的敏感度、特异度、阳性预测值、阴性预测值、假阳性率、假阴性率和诊断符合率。结果 ：50例患者通过床旁超声直接扫查联合注水法定位准确性达100%。结论：床旁超声直接扫查联合注水法，可以快速、便捷、准确判定鼻肠管位置是否位于幽门后，优于听诊法+抽液观察法，具有较高的临床应用价值。

Abstract: Objective: To explore the application value of bedside ultrasound direct scanning combined with water injection in nasointestinal canal localization in severe patients in neurology department. Methods: 50 patients with severe disease who were admitted to the department of neurology of the affiliated hospital of Inner Mongolia medical university on August 1, solstice and November 30, 2019 were selected. After nasointestinal tube implantation, the position of nasointestinal tube head was determined by auscultation and fluid extraction. The specific steps are as follows: (1) Directly probe the cervical esophagus, pyloric hole and the horizontal part of the duodenum in turn, observe and record the position of the nasointestinal tube. If the nasointestinal tube passes through the pyloric hole or is located in the horizontal part of the duodenum, the catheterization is successful; (2) if the position of the nasal and intestinal tube tip cannot be determined by this procedure, the method of water injection is adopted: the probe is first positioned at the horizontal part of the duodenum, and 30ml warm normal saline is injected rapidly from the nasointestinal tube. The rapid increase of duodenal fluid and the liquid rolling sign are observed, then the nasointestinal tube tip is determined to be located at the pylorus, and the catheterization is successful; (3) If it is not determined, the probe shall be positioned to the gastric cavity and continue to inject 100~200ml normal saline. If there is a churning sign or significant increase of gastric fluid in the stomach, the head end shall be judged to be in front of the pylorus, and the catheter shall be judged to be ectopic, and the catheter shall fail. Abdominal X-ray was taken as the gold standard, and the success standard was the pyloric posterior catheterization. The success rate of bedside ultrasound localization of 50 patients was counted, and the sensitivity, specificity, positive predictive value, negative predictive value, false positive rate, false negative rate and diagnostic coincidence rate were compared with auscultation + extraction observation. Results: The accuracy of direct scanning by bedside ultrasound combined with water injection was 100% in 50 patients. Conclusion: The combined method of bedside ultrasound direct scanning and water injection can quickly, conveniently and accurately determine whether the position of nasointestinal tube is located after pylorus, which is superior to the method of auscultation and fluid extraction and has higher clinical application value.