目的 探讨自行研制的可监测pH值胃管借助pH值梯度法指导操作者定位胃管尖端位置的有效性。方法 选取2022-09至2023-02在解放军总医院第一医学中心消化内镜中心行无痛胃镜检查的健康体检者41例,全麻后在胃镜下置入胃管,观察并记录新型胃管尖端到达食管、贲门、胃、幽门、十二指肠时,对应的pH值,绘制不同位置对应的pH值变化曲线图。构建基于pH值梯度法的新型胃管置入流程。41例健康体检者先后随机化分组为接受pH值梯度法（试验组）和常规方法（对照组）两种方式置入胃管。比较两种置入方法胃管尖端位置的准确率、一次置管成功率、操作用时、不良反应发生率等指标,评估pH值梯度法在新型胃管置管过程中的有效性。结果 当新型胃管通过食管移行至食管下括约肌（LES）下缘或贲门附近时,8例呈现明显的pH值下降梯度。试验组置入胃管的位置准确率87.8%,高于对照组的34.1%,差异有统计学意义（P0.05）;试验组的一次置管成功率80.5%,高于对照组的78.0%,但两组差异无统计学意义。试验组完成胃管置入所需时间（99.98±38.60）s,短于对照组的（147.78±58.76）s,差异有统计学意义（P0.05）;胃管置入后,试验组胃内的侧孔数（3.80±0.51）个,多于对照组的（2.85±1.15）个,差异有统计学意义（P0.05）;在置管过程中,发生呛咳和卷曲的差异无统计学意义。结论 可动态监测胃管尖端pH值的新型胃管可以提高胃管置入位置的准确率、一次性置管成功率及置管效率,且不增加胃管置入相关并发症。
Abstract
Objective To explore the effectiveness of a self-developed pH-monitoring gastric tube to guide the operator to locate the tip position by using pH gradient method. Methods Forty-one healthy subjects who underwent painless gastroscopy at the Digestive Endoscopy Center of the First Medical Center of PLA General Hospital from September 2022 to February 2023 were selected. After general anesthesia,gastric tubes were inserted under gastroscopy. The pH values corresponding to the arrival of the tip of the new type of gastric tubes to the esophagus,cardia,stomach,pylorus and duodenum were observed and recorded,and the pH values corresponding to different positions were plotted. A new procedure of gastric tube placement was constructed based on pH gradient method. The participants were randomly assigned to receive a gastric tube inserted by either the pH gradient method （experimental group） or the traditional method （control group）. The accuracy of the tip position of the gastric tubes,the success rate of one insertion, the operation time, the incidence of adverse reactions and other indicators of the two methods were compared to evaluate the effectiveness of the pH gradient method in the process of the new gastric tube insertion. Results When the new gastric tube moved through the esophagus to the lower edge of LES or near the cardia, 8 cases showed a significant gradient of pH value decline. The accuracy rate of the placement of the gastric tube in the experimental group was 87.8%,which was higher than 34.1% in the control group,and the difference was statistically significant （P<0.05）. The success rate of one-time catheterization in the experimental group was 80.5%, which was higher than 78.0% in the control group,but there was no statistical significance between the two groups. The time required for gastric tube placement in the experimental group （99.98±38.60）s was significantly lower than that in control group （147.78±58.76）s, and the difference was statistically significant （P<0.05）. After gastric tube insertion,there were （3.80±0.51）and （2.85±1.15）lateral pores in the stomach of the experimental group and the control group respectively, and the difference was statistically significant （P<0.05）. There was no significant difference in coughing and curling during the catheterization process. Conclusions The new type of gastric tube that can dynamically monitor the pH value at the tip of gastric tube can improve the accuracy of gastric tube placement position,the success rate of one-time catheterization and the efficiency catheterization, without increasing the complications related to gastric tube placement.
关键词
新型胃管 /
胃管留置 /
胃管尖端定位 /
pH值梯度法 /
胃液pH值监测
Key words
nnew type of gastric tube /
gastric tube retention /
tip positioning of gastric tube /
pH gradient /
gastric fluid pH monitoring
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基金
军队护理创新与培育专项计划（2021HL072）
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