社区全科医师运用超声诊断急腹症的效果评价  

Clinical effect of emergency ultrasound used by general practitioners in diagnosis of acute abdomens in community

作　　者：陈光英 陈丽娟 

机构地区：[1]岭南师范学院门诊部,广东湛江524048

出　　处：《中国校医》2016年第7期538-540,共3页Chinese Journal of School Doctor

基　　金：湛江市科技攻关计划项目[201576]

摘　　要：目的评价全科医师运用急诊超声诊断社区急腹症的临床效果。方法 2012年9月至2015年8月,选取本校门诊108例学生急腹症患者作为临床研究对象,由经三级医院超声科脱产培训累计6个月并具有2年以上急诊超声经验的本院高年资全科医师接诊。接诊医师对患者进行初步诊断后均给予急诊超声检查,根据临床表现有目的的快速扫查腹部、盆腔等病变部位,综合评估病情作出急诊超声诊断,指导治疗和处置。对急腹症患者的急诊超声诊断与其入院诊断、出院诊断结果进行比较分析。结果 108例学生急腹症患者急诊超声的诊断符合率为91.67%,显著高于全科医师的入院诊断符合率62.96%(χ2=25.37,P<0.05),其中肠道急腹症、妇产科急腹症、胆囊胆道感染与胆石症、输尿管结石的诊断符合率和非典型胃病鉴别诊断符合率均显著高于全科医师的入院诊断符合率约21.85%,40%,45.45%,20.59%和37.5%(P<0.05)。结论急诊超声在社区门诊的应用显著提高了全科医师诊断急腹症的准确率和效率,有效降低了社区门诊处置急腹症的风险。急诊超声作为全科医师的一项体检技能,准确、方便、快速,在社区急腹症的诊断与鉴别诊断中发挥重要作用,值得在社区急诊中广泛推广应用。Objective To evaluate the clinical effect of emergency ultrasound used by general practitioners in the diagnosis of acute abdomens in community. Methods From September 2012 to August 2015, 108 university student outpatients with acute abdomen were selected to be the research objects by the experienced general practitioners（the general practitioners all hada 6-month ultrasound training from three-level hospitals and had the experience of emergency ultrasound for more than 2years）. The emergency ultrasonography was given to the patients after the initial diagnosis. According to the clinical manifestations of patients, the practitioners rapidly scanned the abdomen, pelvis and other lesions to make the emergency ultrasound diagnosis and guide the treatment and disposal. At the last, the corresponding results were analyzed and compared. Results The emergency ultrasound coincidence rate was 91.67%, which was significantly higher than that of the practitioner＇s admission diagnosis（62.96%）（χ2=25.37, P〈0.05）. More specifically, the diagnostic coincidence rates with emergency ultrasound of acute abdomen of intestinal tract, women obstetric acute abdomen, gallbladder and biliary infection and cholelithiasis, ureteral calculi and the differential diagnosis coincidence rate with atypical gastric disease were significantly higher than the coincidence rates in the general practitioner＇s admission diagnosis by about21.85%, 40%, 45.45% and 20.59% and 37.5%（P〈0.05）. Conclusion The emergency ultrasound significantly increases the general practitioner diagnostic accuracy and efficiency of acute abdomen and effectively reduced the risk of outpatient treatment of acute abdomen in community. As a medical skill for general practitioners, the emergency ultrasound is accurate, convenient and fast and plays a very important role in the diagnosis and differential diagnosis of acute abdomen in the community. Therefore, it is worth of popularizing in the community emergency room.

关 键 词：开业医生 急腹症/超声检查 医院 社区 学校 

分 类 号：R445[医药卫生—影像医学与核医学]