0～6岁先天性心脏病患儿中应用床旁超声技术辅助胃管末端定位效果的随机对照试验OA

Background Determining the real-time position of a nasogastric tube in critically ill young children remains a persistent clinical challenge.Objective To evaluate the clinical utility of bedside ultrasound for confirming the intragastric placement of feeding tubes in children aged 0-6 years with congenital heart disease(CHD).Design Randomized controlled trial.Methods A total of 152 children aged 0-6 years who underwent CHD surgery and required nasogastric tube placement in the cardiac intensive care unit(CCU)were enrolled.An estimated dropout rate of 5%was anticipated.Patients were randomly assigned to either the experimental or control group(76 patients per group)using a block randomization method,with blocks of four children and two allocated to each group.The randomization sequence was generated centrally and stored in sealed envelopes.Both groups received a disposable nasogastric tube inserted via the nostril.In the experimental group,insertion was performed under real-time bedside ultrasound guidance;in the control group,blind(traditional)insertion was used,and tube placement was subsequently confirmed by chest radiography.Primary and secondary outcomes,including first-attempt insertion success rate,insertion time,number of insertion attempts,hemodynamic and oxygenation parameters,procedure-related complications,and gastric tube integrity,were recorded and compared between groups.Blinding was implemented for patients' parents and for all researchers except those directly performing the nasogastric tube insertions.All analyses were conducted according to the intention-to-treat principle.Main Outcome Measures The success rate of one-time tube placement.Results From July 1,2023,to June 1,2024,a total of 152 CHD children who underwent cardiac surgery and were admitted to the CCU of the Children's Hospital of Fudan University were enrolled in this study.Children were randomly assigned to either the experimental group(n=76)or the control group(n=76).No participant withdrew from or was lost to follow-up during the study period.There were no significant differences in baseline data between the two groups(P>0.05).The one-time success rate of nasogastric tube placement was 100%(76/76)in the experimental group versus 81.58%(62/76)in the control group.This difference was statistically significant(χ²=15.420,P<0.001).The median time required for successful tube placement was significantly shorter in the experimental group[4.00(4.00,4.00)min]than in the control group[60.00(43.25,69.75)min].This difference was also statistically significant(Z=-10.969,P<0.001).No significant differences were observed between the two groups in heart rate,arterial blood pressure,respiratory rate,or transcutaneous oxygen saturation measured before,during,and after tube placement.No procedure-related complications or device damage were reported in either group.Conclusion Ultrasound-guided gastric tube placement significantly improves the success rate and reduces the procedural duration of gastric tube insertion and carries no risk of radiation exposure.