床旁超声联合POCT在急诊休克患者中的诊断价值  

The diagnostic value of bedside ultrasound examination combined with POCT in emergency patients with shock

作　　者：刘克琴 张潇月 崔娜[1] 卞慧敏[1] 邵龙刚[1] 赵斌[2] Liu Keqin;Zhang Yuyue;Cui Na;Qi Huimin;Shao Longgang;Zhao Bin(The emergency department of Jiangsu Provincial Second Chinese Medicine Hospital/the Second affiliated hospital of Nanjing university of Chinese medicine, Nanjing, China;Nanjing Hospital of Chinese Medicine, Nanjing, China)

机构地区：[1]江苏省第二中医院/南京中医药大学附属第二医院急诊医学科 [2]江苏省南京市中医院

出　　处：《实用休克杂志（中英文）》2018年第5期291-295,共5页Journal of Practical Shock

基　　金：南京市科技项目(项目编号:201611009)

摘　　要：目的本研究旨在评价急诊床旁超声快速筛查联合即时检验(POCT),包括肌红蛋白(MYO)、肌钙蛋白I(TnI)、肌酸激酶同工酶(CK-MB)、B-型脑钠肽(BNP)、D-二聚体五项在休克患者中的诊断价值。方法回顾性分析江苏省第二中医院急诊科救治的60例休克患者,根据床边超声快速筛查肺、心包、心脏、下腔静脉、腹主动脉及分支、深静脉,可疑感染的行肝胆胰脾、双肾及腹腔探查,结合POCT五项的结果初步判断休克的原因,与结合症状、体征、相应的影像学、进一步检验结果、治疗反应性所做的综合评估得出最终的诊断结果相比较,比较诊断符合率。结果60例休克患者中,急诊诊断心源性休克13例、梗阻性休克4例、感染性休克32例、感染性合并心源性休克1例,低血容量性休克4例,5例未能明确休克原因,有1例感染性休克误诊为心源性休克。急诊床旁超声联合POCT五项对休克的病因诊断正确率90.00%。结论床边超声快速筛查联合POCT五项可准确快速判断休克的原因,及时准确地给予适当的治疗。Objective The research investigated the diagnostic value of emergency bedside ultrasound examination combined with the POCT(point-of-care testing)of myoglobin(MYO),troponin I(TnI),creatine kinase isozyme(CK-MB),B-type natriuretic peptide(BNP),D-dimer in emergency patients with shock.Methods We collected 60 unexplained shock patients in the emergency department of Jiangsu Provincial Second Chinese Medicine Hospital.The bedside ultrasound screened the lung,pericardium,heart,inferior vena cava,abdominal aorta and branches and deep veins rapidly.The liver,gallbladder,pancreas,spleen,double kidney and abdominal cavity were examined for suspicious infection.All the causes of shock were preliminarily judged by the results of the bedside ultrasound screened and POCT five items.The final results required clinicians to combine the symptoms,signs,corresponding imaging,further examination results and treatment reactivity to make a comprehensive assessment,then comparative diagnostic coincidence rate.Results Among the 60 cases of shock,13 cases of cardiogenic shock,4 cases of obstructive shock,32 cases of septic shock,1 cases of infectious combined with cardiogenic shock,4 cases of hypovolemic shock,5 cases failed to clarify the cause of shock,1 cases of septic shock were misdiagnosed as cardiogenic shock.The diagnostic accuracy of emergency bedside ultrasound combined with POCT five items on the etiology of shock is 90.00%.Conclusions The emergency bedside ultrasound examination combined with the POCT cardiopulmonary five items could judge the cause of shock rapidly,and give the appropriate treatment for patients in time and accurately.

关 键 词：床旁超声 POCT 休克 

分 类 号：R459.7[医药卫生—急诊医学]