目标导向重症超声在芦山地震创伤伤员应急救治中的作用  

Value of focused critical ultrasound in the treatment of critical patients in Lushan earthquake

作　　者：尹万红[1] 周然[1] 吴红[1] 左艳艳[1] 王波[1] 胡成功[1] 金晓东[1] 王小亭[2] 康焰[1] 

机构地区：[1]四川大学华西医院重症医学科,成都610041 [2]中国医学科学院北京协和医学院北京协和医院重症医学科

出　　处：《中华医学杂志》2014年第15期1135-1138,共4页National Medical Journal of China

摘　　要：目的探讨目标导向重症超声在芦山地震创伤伤员应急救治中的作用。方法回顾2013年4月芦山地震伤员救治中床旁超声使用情况，分析统计超声提供的有用的信息、超声使用后对治疗方案的影响及临床效果。结果有资料的床旁超声检查107例次，资料分析示可提供有用临床信息97例次（90．7％），包括循环评估44例次，肺部超声58例次（部分伤员同时进行循环及肺超评估）；循环评估中通过对心功能的评估重启已中止的液体复苏8例次（8／44，18．2％），终止高风险液体复苏2例次。临床容量判断错误8例次（8／44 18．2％），超声检查后修正治疗方案。超声共影响循环支持方案18例次（18／44，40．9％），临床效果证实超声改变方案正确性。肺部超声检查主要用于：液体复苏中的肺水监测6例次；撤机前肺超检查17例次（指导引流胸水10例次，同时或单独肺复张8例次）；使用改良BLUE方案检查32例次，其中发现肺不张、实变24例次（75．0％），均采取肺部物理治疗。其他部位检查包括发现血栓、胆道感染、颅内感染等。结论目标导向重症超声在地震创伤伤员中能够提供可靠的临床信息，改变治疗决策，并能减少辅助检查环节，加快治疗的开展。Objective To explore the value of focused critical ultrasound in the treatment of critical patients in Lushan earthquake. Methods The utilization of bedside ultrasound and its effects on the treatment of critical patients in Lushan earthquake were retrospectively analyzed. Results After brief training of resident doctors, bedside ultrasound was performed for 107 sessions. And 97 sessions（90.7% ）of ultrasound exams were valuable for diagnosis and treatment. The exams included hemodynamic monitoring for 44 sessions and bedside lung ultrasound for 58 sessions. In hemodynamic monitoring, after heart function estimation, fluid resuscitation was restarted in 8 cases （8/44, 18.2% ）and terminated in 2 cases to control risks. False estimate of volume by clinical experience were 8 sessions （ 8/44, 18.2% ）. And corrections were made after ultrasound exams. A total of 18 cases（ 18/44, 40. 9% ） of hemodynamic treatments improved with the help of focused critical ultrasound. Bedside lung ultrasound was performed to monitor the change of lung water in fluid resuscitation 6 sessions and guide the pleural fluid drainage and lung recruitment before weaning 17 sessions; the BLUE-plus lung ultrasound protocol was performed for 32 sessions. And 24 cases of lung consolidation and atelectasis were found. Chest physiotherapy was then performed. The focused critical ultrasound exam was also performed to locate thrombus, biliary infection and intraeranial infection, etc. Conclusion Focused critical ultrasound can provide reliable clinical information to reduce unnecessary examination and optimize therapies for Lushan earthquake victims.

关 键 词：超声检查 诊断 治疗 自然灾害 危重症 

分 类 号：R445.1[医药卫生—影像医学与核医学] R641[医药卫生—诊断学]