重症超声对心脏外科术后低氧血症患者病因诊断的价值  

The value of critical care ultrasonography in the diagnosis of the etiology of hypoxemia after cardiac surgery

作　　者：张颖[1] 罗哲[1] 刘岚[1] 杨晓梅[1] 庄亚敏[1] 刘华[1] 马国光[1] 屠国伟[1] 

机构地区：[1]复旦大学附属中山医院重症医学科,上海200032

出　　处：《中国临床医学》2016年第3期330-333,共4页Chinese Journal of Clinical Medicine

基　　金：国家自然科学基金(81500067);上海市卫生和计划生育委员会科研课题(20154Y011;201440333);中山医院人才培养计划-优秀骨干计划(2015ZSYXGG-01)~~

摘　　要：目的:探讨重症超声在心脏外科术后低氧血症患者中的病因诊断价值。方法:选择2015年8月至2016年1月复旦大学附属中山医院重症医学(ICU)科接受心脏外科术后低氧血症患者68例,首先采用常规检查进行低氧血症病因分析,包括:病史、体格检查、实验室检查和X线等;再由具有重症超声经验的ICU医生进行床旁心、肺超声诊断,并与最终诊断结果进行匹配,对比分析重症超声诊断效能。结果:68例患者中最终确诊气胸6例,肺水肿24例,肺实变12例,胸腔积液14例。常规检查及重症超声诊断气胸的敏感性和特异度分别为50.0%vs 85.7%和98.4%vs 98.4%;诊断肺水肿的敏感性和特异度分别为75.0%vs 83.3%和79.5%vs 86.4%;诊断肺实变的敏感性和特异度分别为50.0%vs 83.3%和91.1%vs 96.4%;诊断胸腔积液的敏感性和特异度分别为57.1%vs 100%和88.9%vs 100%。结论:重症超声对心脏外科术后低氧血症患者病因诊断的效能优于常规临床检查,值得推广采用。Objective：To assess the value of critical care ultrasonography in the diagnosis of the etiology of hyoxemia after cardiac surgery.Methods：Sixty-eight patients with hypoxemia who underwent cardiac surgery from August 2015 to January 2016 in Zhongshan Hospital,Fudan University were included in the study.Then,after the primary clinical assessment,point-of-care ultrasonography of the heart and lungs was done by ICU doctors with experience in critical care ultrasonography（critical care ultrasonography group）.The final diagnosis results were matched,and the performance of critical care ultrasonography was compared and analyzed.Results：In the final diagnosis of 68 cases,there were 6 cases of pneumothorax,24 cases of pulmonary edema,12 cases of pulmonary consolidation and 14 cases of pleural effusion.The sensitivity and specificity of routine examination and critical care ultrasonography for the diagnosis of pneumothorax were50.0%vs 85.7% and 98.4%vs 98.4%;pulmonary edema 75.0%vs 83.3% and 79.5%vs 86.4%;pulmonary consolidation50.0%vs 83.3% and 91.1% vs 96.4%;pleural effusion 57.1% vs 100% and 88.9% vs 100%.Conclusions：This study suggested that critical care ultrasonography has relatively higher sensitivity and specificity for pneumothorax,pulmonary edema,consolidation and pleural effusion compared with routine clinical examination.The use of critical care ultrasonography appears to be an attractive complementary diagnostic tool to clarify the cause of hypoxemia and seems able to contribute to an early therapeutic decision.

关 键 词：危重症 超声检查 心脏手术 低氧血症 

分 类 号：R654.2[医药卫生—外科学]