临床医师应用超声检查快速评估ICU严重创伤患者的研究  

Study on rapid assessment of severe trauma patients in ICU by clinician-performed ultrasound

作　　者：张茂[1,2] 巴立[1,2] 洪玉才[1,2] 周光居[1,2] 杨俭新[1,2] 徐善祥[1,2] 干建新[1,2] 徐少文[1,2] 

机构地区：[1]浙江大学医学院附属第二医院急诊医学科 [2]浙江大学急救医学研究所,浙江杭州310009

出　　处：《创伤外科杂志》2011年第2期119-122,共4页Journal of Traumatic Surgery

摘　　要：目的探讨临床医师应用超声检查快速评估ICU严重创伤患者的可行性和临床意义。方法由经过规范培训的临床医师应用超声检查对148例初收住ICU的严重创伤患者进行胸腹腔和心包腔的评估,根据有无气胸和游离液体判断胸腹腔及心包是否损伤,并与临床确诊结果(经CT检查、手术及随访确定)及常规超声科的超声检查进行比较。结果 148例中经临床医师超声检查评估发现胸腔积液45例,气胸16例,心包积液6例,腹腔积液24例,假阴性为胸腔积液2例、气胸4例、心包积液1例、腹腔积液4例。其中对胸腹腔及心包游离液体的评估结果与常规超声检查无明显差异(均P>0.05),并且其诊断的敏感性、特异性及准确率均较高,与常规超声检查比较也均无明显差异(均P>0.05),而对气胸诊断的敏感性、特异性及准确率分别达到80.0%、100.0%及97.3%。结论经过适当培训的临床医师利用超声检查对ICU严重创伤患者进行胸腹腔和心包的快速评估,具有较高的准确性和便利性,值得推广应用。Objective To investigate the clinical significance and feasibility of performing ultrasound by clinicians for rapid assessment of severe trauma patients in ICU.Methods Totally 148 severe trauma patients admitted to emergency ICU were enrolled,and bedside sonography focused on chest,abdomen and pericardium were performed by qualified ICU doctors.It was judged as positive when gas or free fluid was detected in thoracic cavity,abdomen or pericardium.The clinical result confirmed by CT scan,operation and follow-up was regarded as a golden standard.Then the values of sonography performed by clinicians were compared with that performed by ultrasound doctors.Results The result of sonography performed on the 148 patients showed that pleural effusion was positive in 45 patients,pneumothorax in 16 patients,pericardial effusion in 6 patients and ascites in 24 patients.And pleural effusion was false negative in 2 patients,pneumothorax in 4 patients,pericardial effusion in 1 patient and ascites in 4 patients respectively.There was no significant difference between the result of sonography performed by clinicians and that performed by ultrasound doctors in the evaluation of free fluid in splanchnocoel and pericardium（P〉0.05）.There was also no significant difference in sensitivity,specificity and accuracy（P〉0.05）.The sensitivity,specificity and accuracy in the diagnosis of pneumothorax by clinician-performed ultrasound was 80.0%,100% and 97.3% respectively.Conclusion After proper training,clinicians can perform rapid assessment of the pleural,peritoneal and pericardial cavity by ultrasound in severe trauma patients with higher accuracy and convenience,and therefore it deserves further application in trauma care.

关 键 词：超声检查 创伤 重症监护 评估 

分 类 号：R64[医药卫生—外科学] R445.1[医药卫生—临床医学]