ABSTRACT
Objective To assess the value of bedside gastrointestinal ultrasound combined with gaswater alternate injection on nasointestinal tube positioning in critically ill patients.Methods A total of 62 critically ill patients requiring post-pyloric enteral nutrition admitted to the intensive care unit in our Hospital from May 1,2017 to December 1,2017 were enrolled.Nasointestinal tubes were blindly inserted in a bedside setting.Then,we evaluated the nasointestinal tube position using both an ultrasound with gas-water alternate injection and the traditional auscultation method after gas perfusion.Abdominal X-ray imaging was also performed in all cases as the gold standard,and the sensitivities,specificities,positive predictive values,negative predictive values,and accuracies of the tested methods were obtained.Results Sixty-two patients were confirmed by X-ray,wherein 55 were successfully catheterized and 7 were ectopic.The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of ultrasound-assisted gas-water injection were 90.9％,100％,100％,58.3％,and 91.9％,respectively,which were all higher than those of traditional gas perfusion auscultation (P ＜ 0.05).Conclusion The bedside gastrointestinal ultrasound with gas-water alternate injections for nasointestinal tube positioning in critically ill patients has a certain clinical value.
ABSTRACT
Objective To evaluate the six scoring systems and four laboratory tests,including pancreatitis outcome prediction (POP),Ranson score,bedside index for severity in acute pancreatitis (BISAP),acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ),systemic inflammatory response syndrome (SIRS),and Glasgow score as well as four laboratory tests including C-reactive protein (CRP),hematocrit (HCT),blood urea nitrogen (BUN) and serum creatinine (Scr) in the prognostic assessment of severe acute pancreatitis (SAP).Methods From January 2016 to December 2017,at Sir Run Run Shaw Hospital,151 SAP patients who met the enrollment criteria were retrospectively analyzed.According to the time from onset to treatment,the patients were divided into less than three days group (n=102) and over three days group (n=49).The evaluation of six scoring systems and four laboratory tests,including CRP,HCT,BUN and Scr at 0,24 and 48 h after hospitalization in the prognostic assessment of SAP patients was measured by receiver-operating characteristic (ROC) curve.Results The Ranson score had the highest area under curve (AUC) value (0.916) in the evaluation of the prognosis of SAP patients less than three days group followed by BISAP,APACHE Ⅱ,Glasgow and POP score,and their AUC values were 0.832,0.823,0.793,and 0.787,respectively,all of them were statistically significant in the prognostic assessment of SAP patients in less than three days group (all P＜0.05).There were statistically significant of BISAP and APACHE Ⅱ scores in the prognostic evaluation of SAP patients in over three days group (both P＜0.05),and the AUC values were 0.751 and 0.735,respectively,which were less than those of SAP patients in less than three days group.There were statistical significance of BUN and Scr at 24 and 48 h after hospitalization in the prognostic assessment of SAP patients in less than three days group (all P＜0.05),and the AUC values were 0.856,0.853 and 0.793,0.874,respectively.There were statistical significance of BUN at 0,24,48 h and Scr at 48 h after hospitalization in the prognostic assessment of SAP patients in over three days group (all P＜0.05),and the AUC value was 0.709,0.754,0.742 and 0.716,respectively.Conclusions Ranson,POP and Glascow score systems are only suitable for patients with SAP less than three days.APACHE Ⅱ,BISAP score systems,BUN and Scr can be used to evaluate patients with SAP over three days,but are more suitable for patients with SAP less than three days group.