初学者应用5分钟A-F简便记忆法床旁超声心动图在诊断急性胸痛中的价值  

Diagnostic value of bedside echoeardiography with simple A-F mnemonic within 5 minutes by beginners in patients with acute chest pain

作　　者：杨黎明[1,2] 赵博文[1,2] 洪玉才[2,3] 王蓓[1,2] 彭晓慧[1,2] 李强[1,2] 李秀茹 郁聪[1,2] 韩英[1,2] Yang Liming;Zhao Bowen;Hong Yucai;Wang Bei;Peng Xiaohui;Li Qiang;Li Xiuru;Yu Cong;Han Ying(Department of Diagnostic Ultrasound &Echocardiography,Sir Run Run Shaw Hospital Zhejiang University College of Medicine,Hangzhou 310016,China;Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University,Hangzhou 310016,China;Department of Critical Medicine,Sir Run Run Shaw Hospital Zhejiang University College of Medicine,Hangzhou 310016,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院超声科,杭州310016 [2]浙江大学邵逸夫临床医学研究所,杭州310016 [3]浙江大学医学院附属邵逸夫医院危重医学科,杭州310016

出　　处：《中华急诊医学杂志》2019年第1期90-95,共6页Chinese Journal of Emergency Medicine

基　　金：浙江省公益技术应用社会发展项目(LGF18H180004);浙江省医药卫生科研项目(2019ZD033).

摘　　要：目的探讨初学者应用5分钟A-F简便记忆法床旁超声心动图检查在诊断急性胸痛患者中的价值。方法前瞻性观察研究,选择6名初学者,应用5分钟A-F简便记忆法急诊床旁经胸超声心动图,对急性胸痛患者进行初步快速诊断,主要评估是否存在升主动脉夹层(A,aorta),右心室扩张(B,bothventricles),左室节段性室壁运动异常、左室收缩功能LVEF≤50%(C,contractility)、左室扩张(D,dimensions),心包积液(E,effusion),其他异常(F,furtherabnormalities)等。同时,由专业心超医师完成同样上述检查,记录两者检查耗时。以专业心超医师的诊断结果为"标准",使用Kappa检验来分析两者诊断的一致性,分析初学者诊断的敏感度、特异度、阳性预测值、阴性预测值。结果符合纳入条件病例245例,排除20例。225例急性胸痛患者纳入研究。其中致命性胸痛158例,非致命胸痛67例。各项观察指标中,专业心超医师检查结果阳性:升主动脉夹层20例,右心室扩张8例,左室壁节段性运动异常72例,LVEF≤50%41例,左室增大45例,心包积液7例,其他异常(主动脉瓣异常)7例。分析两者一致性:心包积液(Kappa=1.000)诊断结果完全一致;升主动脉夹层(Kappa=0.853)、右心室扩张(Kappa=0.931)、其他异常(主动脉瓣异常)(Kappa=0.829)一致性优;左室节段性室壁运动异常(Kappa=0.768)、LVEF≤50%(Kappa=0.713)、左室扩张(Kappa=0.766)一致性良。左室节段性室壁运动异常、LVEF≤50%敏感度、阴性预测值略低,左心室扩张阳性预测值略低。初学者应用A-F简便记忆法行床边心超检查,96%患者(216/225)的检查时间小于5min。结论5分钟A-F简便记忆法床旁超声心动图检查方法简单、实用,易于初学者接受,能对大多数急诊胸痛患者做出准确诊断,为临床提供快速可靠的诊断信息,具有一定临床应用价值。ObjectiveTo evaluate the diagnostic value of A-F mnemonic performed by sonographers with limited experience in patients with acute chest pain.MethodsThis was a prospective observational study. Bedside cardiac ultrasound for patients with chest pain was performed by six sonographers with limited experience using A-F mnemonic, evaluating indexes including aortic dissection(A), both ventricles (B), regional wall motion abnormality (RWMA), left ventricular ejection fraction (LVEF)≤50% (C ,contractility), dimensions (D), pleural and pericardial effusion (E) and further abnormalities (F). Afterwards, experienced cardiac sonographers performed the same examinations, and the difference in the time of ultrasound examination was calculated. The diagnosis of experienced sonographers were referred as the control group, and kappa test was applied to analyze the sensitivity, specificity, positive predictive value and negative predictive value.ResultsThere were 245 cases eligible for study, and 20 cases were excluded. Finally 225 cases of acute chest pain were included in the analysis, containing 158 fatal chest pain and 67 low-risk chest pain. The experienced sonographers diagnosed 20 cases of ascending aortic dissection, 5 cases of right ventricular dilatation, 72 cases of RWMA, 12 cases of LVEF≤50%, 45 cases of left ventricular dilatation, 6 cases of hydropericardium, and 6 cases of other abnormalities. The consistency between beginners and experienced sonographers were as follows: completely same (hydropericardium, Kappa=1.000), highly consistent (ascending aortic dissection, Kappa=0.853, right ventricular dilatation, Kappa=0.931, and other abnormalities, Kappa=0.829), moderately consistent (RWMA, Kappa=0.768, LVEF≤50%, Kappa=0.713 and left ventricular dilatation, Kappa=0.766). The sensitivity and negative predictive value of RWMA and LVEF≤50% and the positive predictive value of left ventricular dilatation in the beginner sonographers were lower than those in the experienced sonographers.ConclusionsA-F mnemonic was

关 键 词：急性胸痛 急诊 床旁超声心动图 A-F简便记忆法 

分 类 号：R459.7[医药卫生—急诊医学] R540.45[医药卫生—治疗学]