床边CR胸片在ICU患者疾病诊断中的作用  

Bedside Chest Radiography in the Intensive Care Unit

作　　者：周全[1] 刘斯润[1] 陈金城[1] 刘晖[2] 

机构地区：[1]暨南大学附属第一医院医学影像中心,广东广州510632 [2]暨南大学附属第一医院ICU,广东广州510632

出　　处：《实用放射学杂志》2008年第5期600-603,共4页Journal of Practical Radiology

基　　金：广东省自然科学基金项目(编号:06025211)

摘　　要：目的评估床边胸片在ICU的临床应用价值。方法对193例ICU患者的507份床边胸片并结合其临床资料进行回顾性分析,观察其心肺疾病表现。结果约97.4%的床边胸片符合诊断要求。83.9%的床边胸片显示有心肺疾病,包括有肺不张、肺炎、肺水肿、成人呼吸窘迫综合征(ARDS)、气胸、纵隔及皮下气肿、胸腔积液、心包积液及肺栓塞。在阳性病例中有6.2%是其它原因摄胸片时意外发现病变的。结合临床,床边胸片对肺不张、肺炎、肺水肿、胸腔积液的初次诊断的准确性较高,达77.9%左右。误诊、漏诊主要为对少量气胸、肺梗塞的诊断,约1/3的心衰肺水肿与ARDS的鉴别诊断存在困难。结论床边胸片在ICU患者病因诊断、疗效观察、新病变的发现等方面有着非常重要的作用。Objective To evaluate the applied value of bedside chest radiography in the intensive care unit （ ICU ） . Methods One hundred and ninety -three cases with 507 chest radiographs （ CXRs） in the ICU were analysed retrospectively. The appearances of cardiop- ulmonary abnormalities were analysed. Results 97.4% of the CXRs were satisfied for diagnosis. 83.9% of the CXRs showed cardiopulmonary abnormalities, including atelectasis, pneumonia, pulmonary edema, ARDS, pneumothorax, mediastinal and subcataneous emphysema, pleural effusion,pericardial effusion and pulmonary thromboembolism, and 6.2% out of these positive cases was discovered accidentally. The chest radiograph has moderate accuracy （ 77.9% ） in visualizing cardiopulmonary abnormalities at the initial CXR including atelectasis, pneumonia, pulmonary edema and pleural effusion. Misdiagnosis occurred mainly on the patients with a small quantity of pneumothorax and pulmonary thromboembolism. About one - third cases of cardiogenic edema and ARDS were indistinguishable. Conclusion Bedside chest radiographs are of significant value for the patients in the ICU.

关 键 词：胸部 床边X线摄影 ICU 并发症 

分 类 号：R323.2[医药卫生—人体解剖和组织胚胎学] R814.41[医药卫生—基础医学]