重症监护病房床旁超声对胸部严重多发伤患者的诊断价值  

Diagnostic value of bedside ultrasound on patients with severe multiple chest injury in intensive care unit

作　　者：王湘江[1] 桑云华[1] 吕强 WANG Xiangjiang;SANG Yunhua;LV Qiang(Intensive Care Unit,Huizhou Third People’s Hospital,Guangdong 516000,China)

机构地区：[1]广东省惠州市第三人民医院重症监护病房,516000

出　　处：《临床超声医学杂志》2020年第5期385-387,共3页Journal of Clinical Ultrasound in Medicine

摘　　要：目的探讨重症监护病房(ICU)应用床旁超声对胸部严重多发伤患者的诊断价值。方法以我院ICU收治的120例严重多发伤患者为研究对象,均行胸部床旁超声检查,并在超声检查后2 h内行胸部X线检查。以CT检查或手术探查结果为金标准,比较床旁超声与X线检查胸部严重多发伤的诊断效能。多因素回归分析床旁超声诊断的影响因素。结果120例患者经CT检查或手术探查证实胸部严重多发伤60例,包括合并胸腔积液28例、肺挫伤12例、气胸10例、心包积液7例、创伤性膈疝3例。床旁超声诊断结果与X线比较,其对胸腔积液(92.86%vs.71.43%)、肺挫伤(83.33%vs.50.00%)、气胸(90.00%vs.50.00%)、心包积液(100%vs.14.29%)的诊断符合率差异均有统计学意义(均P<0.05)。床旁超声对胸部严重多发伤的敏感性、特异性、准确率分别为90.00%、100%、95.00%,与X线(76.67%、95.00%、85.83%)比较,敏感性和准确率差异均有统计学意义(均P<0.05)。多因素回归分析显示就诊时间>1 h、多发脏器损伤、ICU医师工作年限>5年均是影响床旁超声诊断效能的独立因素(均P<0.05)。结论ICU应用床旁超声能够快速准确地评估胸部严重多发伤患者,缩短抢救时间,提高抢救时效性。Objective To explore the diagnostic value of bedside ultrasound on patients with severe multiple chest injury in intensive care unit(ICU).Methods A total of 120 patients with severe multiple injuries in ICU of our hospital were taken as the research objects.All the patients were detected by bedside ultrasound and X-ray within 2 h after ultrasound examination.The diagnostic results of CT examination or surgical exploration were taken as gold standard,the diagnostic efficiency of bedside ultrasound and X-ray were observed and compared.Multivariate regression analysis was performed on the influencing factor of bedside ultrasound.Results One hundred and twenty patients were confirmed as 60 severe multiple chest injuries by CT examination or surgical exploration,including 28 cases of pleural effusion,12 cases of pulmonary contusion,10 cases of pneumothorax,7 cases of pericardial effusion,3 cases of traumatic diaphragmatic hernia.The diagnostic coincidence rate of bedside ultrasound and X-ray on pleural effusion(92.86% vs.71.43%),pulmonary contusion(83.33%vs.50.00%),pneumothorax(90.00%vs.50.00%),pericardial effusion(100% vs.14.29%)were significantly higher than those of X-ray(all P<0.05).The sensitivity,specificity,and accuracy of bedside ultrasound for severe chest trauma were 90.00%,100%,and 95.00%,respectively.Compared with X-rays(76.67%,95.00%,and 85.83%),there were statistical differences in sensitivity and accuracy(both P<0.05).Clinic time>1 h,multiple organ injuries and work experience of ICU physician>5 years were independent factors that could affect the diagnostic efficiency of bedside ultrasound diagnosis(all P<0.05).Conclusion Bedside ultrasound can quickly and accurately evaluate patients with severe multiple chest injuries in ICU,shorten the rescue time and improve rescue timeliness.

关 键 词：超声检查 床旁 严重多发伤 胸部 X线 诊断价值 

分 类 号：R445.1[医药卫生—影像医学与核医学]