急诊床旁创伤重点超声评估结合区域脏器重点超声检查在闭合性腹部创伤中的应用  

Application of emergency bedside focused assessment with sonography for trauma together with regional organ focused ultrasonography in closed abdominal trauma

作　　者：陶杰[1] 吴晓波[1] 陈重[1] 虞俊[2] 邓旦[1] 赵恒[1] 高玲[1] 

机构地区：[1]成都军区总医院超声科,610083 [2]成都军区总医院急诊科,610083

出　　处：《中华创伤杂志》2014年第2期138-141,共4页Chinese Journal of Trauma

摘　　要：目的 探讨急诊床旁针对创伤的重点超声评估（focused assessment with sonography for trauma,FAST）技术结合区域脏器重点超声检查在腹部闭合性创伤患者中的应用价值. 方法 我院急诊科内行床旁超声检查的腹部闭合性创伤患者237例.对于血流动力学不稳定或伴有重型颅脑损伤患者,FAST筛查后立即结束超声检查；对于生命体征平稳的患者,FAST筛查后根据致伤机制、致伤的外力作用部位及方向、患者腹部症状与体征确定重点扫查区域,对相应脏器进行创伤检查.以手术及CT扫描结果作为金标准与超声检查结果进行比较. 结果 （1）FAST技术对于腹腔脏器破裂伤、需紧急手术的腹腔脏器破裂伤所至腹腔积液的诊断敏感度分别为79.3％、100％；FAST技术总的特异度为98.2％,阳性预测值93.9％,阴性预测值为86.7％.（2）区域脏器重点超声检查单脏器损伤超声诊断符合率为91.2％；多脏器损伤超声诊断符合率为63.6％；漏诊以挫伤及脏器细小裂伤为主. 结论 FAST技术可快速筛查需紧急处理的腹腔脏器破裂导致血流动力学不稳定的患者.区域脏器重点超声检查可提高脏器损伤诊断符合率,减少漏诊.Objective To investigate the value of emergency bedside focused assessment with sonography for trauma （FAST） in combination with regional organ focused ultrasonography in patients with closed abdominal trauma. Methods Two hundred and thirty-seven patients with closed abdomi- nal trauma underwent bedside uhrasonography in the Emergency Department at General Hospital of Chengdu Military Command. In patients with unstable hemodynamics or severe craniocerebral injury, uhrasonography was ended immediately after FAST screening. In patients with stable vital signs, the fo- cused regional organ injury after FAST screening was determined based on the mechanism of trauma, action location and direction of external force, abdominal symptoms, and signs. The results of operation and CT scanning were considered as golden criteria and used to compare with those of nltrasonography. Results （ 1 ） The diagnostic sensitivity of FAST to abdominal organ rupture and ascites due to abdom- inal organ rupture calling for emergency operation was 79.3% and 100%, respectively. The total speci- ficity of FAST was 98.2% , positive predictive value 93.9% , and negative predictive value 86.7%. （2） The diagnostic accordance rate of single visceral injury examined by regional organ focused ultra- sonography was 91.2% and that of multiple visceral injury was 63.6%. The missed diagnoses were predominantly contusion and microlaceration. Conclusions FAST can quickly screen out the patients with unstable hemodynamics due to abdominal organ rupture calling for emergency management. Regional organ focused ultrasonography can increase the rate of correct diagnosis of visceral injury and decrease the rate of missed diagnosis.

关 键 词：腹部损伤 超声检查 急诊处理 

分 类 号：R656[医药卫生—外科学]