重氮试验辅助ICU鼻肠置管后尖端位置判定的效果对比研究OA
The effectiveness of the diazo reaction in the determination of tip-end position after blind insertion of the nasoenteric tube by ICU nurses:A prospective comparative study
目的 探讨重氮试验对ICU卧床患者盲插鼻肠管尖端位置的预测价值,并将其诊断准确性与其它常用床旁方法进行比较.方法 采用前瞻性对照研究设计,在山东省1所三级甲等医院ICU连续纳入2021年6月至2022年1月期间需行盲插鼻肠管置管的436例患者.分别采用重氮试验、听诊气过水声法、导丝回弹试验、负压试验、消化液性状判断及pH检测等方法判断导管尖端位置,并以X线检查结果作为金标准进行确认.计算并比较各方法的诊断参数,包括准确率、敏感度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比、约登指数、Kappa 一致性系数及受试者工作特征曲线下面积.结果 共计427例患者均完成了上述6种诊断方法.重氮试验的准确率和Kappa一致性系数最高,分别为92.3％和0.767,其受试者工作特征曲线下面积最大,为0.879(95％CI:0.829～0.929),约登指数亦最高(0.757).pH检测法的敏感度(97.3％)和阴性预测值(83.0％)最高;消化液性状判断则在特异度(83.5％)、阳性预测值(94.9％)及阳性似然比(5.030)方面表现最优.结论 重氮试验在ICU患者盲插鼻肠管位置判定方面表现出优异的诊断性能,其整体准确性和一致性优于传统床旁方法,有助于实现精准的床旁置管管理.
Objectives:This study aimed to investigate the predictive value of the diazo reaction for determining the tip position of blindly inserted nasoenteric tubes in ICU bedridden patients,and to compare its diag-nostic accuracy with other common bedside methods. Methods:This prospective comparative study was conducted in the ICU of a tertiary hospital.A consecutive sample of 438 patients requiring blind nasoenteric tube insertion was enrolled from June 2021 to January 2022.The tip position was pre-determined using the diazo reaction,the auscultation of water sound,the guidewire rebound test,the negative pressure test,assessment of the nature of the digestive fluid,and the pH test.The final confirmation was obtained through X-ray analysis.Diagnostic parameters,including accuracy,sensitivity,specificity,positive and negative predictive values,positive and negative likelihood ratios,Youden's index,the Kappa coefficient,and the area under the receiver operating characteristic(ROC)curve(AUC),were calculated and compared. Results:A total of 427 patients completed the diagnostic methods described above.The diazo reaction demonstrated the highest accuracy and Kappa coefficient,with values of 92.3％and 0.767,respectively.It also exhibited the most significant AUC of 0.879(confidence interval:0.829-0.929)and the highest Youden's index of 0.757.The pH test determination method achieved the highest sensitivity and negative result rates,at 97.3％and 83.0％,respectively.The process for assessing the nature of digestive fluid yielded the highest values for specificity,positive predictive value,and favorable likelihood ratio,at 83.5％,94.9％,and 5.030,respectively. Conclusions:The diazo reaction demonstrates excellent diagnostic performance in verifying the tip position of blindly inserted nasoenteric tubes in ICU patients.It offers superior overall accuracy and consistency compared with conventional bedside methods,representing a reliable and patient-friendly strategy for facilitating accurate bedside placement.
宋淳;刘青;张鲁;温坤;李燕;仲秀玲;王晓云;李丽
重氮试验肠内营养鼻肠管重症监护室前瞻性研究
Diazo reactionEnteral nutritionGastrointestinal intubationIntensive care unitsProspective study
《国际护理科学（英文）》 2026 (4)
428-434,7
This work was supported by the Shandong Province Medical Staff Science and Technology Innovation Program[SDYWZGKCJHLH202236].
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