重症超声FALLS流程在休克类型早期识别中的应用价值  

Application value of critical ultrasound falls procedure in early identification of shock types

作　　者：张烨 张诗渊[2] 张功伟 李金[1] 王义兵[1] 王伟[1] ZHANG Ye;ZHANG Shiyuan;ZHANG Gong-wei;LI Jin;WANG Yibing;WANG Wei(Department of Emergency Medicine,the Second Affiliated Hospital of Nanchang University,Nanchang,330006,China;Department of Ultrasound Medicine,the Second Affiliated Hospital of Nanchang University)

机构地区：[1]南昌大学第二附属医院急诊科,南昌330006 [2]南昌大学第二附属医院超声科 [3]武汉大学人民医院东院重症医学科,武汉430060

出　　处：《临床急诊杂志》2022年第2期138-142,共5页Journal of Clinical Emergency

基　　金：江西省科技厅重点研发计划项目(No:20181BBG78032)。

摘　　要：目的:探讨急诊科医生应用重症超声FALLS流程在休克类型早期识别的效果及可行性。方法:选取南昌大学第二附属医院急诊科2018年5月-2020年6月期间收治的休克患者210例,在不耽误这些患者救治前提下,观察组由经过重症超声培训合格的急诊科医生按照肺部超声指导的液体管理(FALLS)流程对这210例患者实行床旁超声探查测量,同时对照组由高年资超声科医生对这210例患者按照常规超声流程探查测量,以最终的临床诊断(症状、体征、既往史及辅助检查)为金标准,对比分析两组不同超声方法诊断休克类型的诊断时间与诊断效能。结果:观察组诊断时间为平均(8.32±1.03)min,对照组诊断时间为平均(12.36±1.11)min,观察组诊断时间较对照组显著缩短,差异均有统计学意义(P<0.05);观察组诊断休克类型的敏感度为100%,观察组诊断结果的敏感度和阳性预测值均高于对照组(100.00%vs.91.46%,21.09%vs.3.91%,均P<0.05);进一步揭示两组的诊断效能,观察组诊断休克类型的AUC(0.851)高于对照组(0.575),差异有统计学意义(P<0.05)。结论:急诊科医生应用重症超声FALLS流程对休克患者进行检查测量,有助于快速评估和明确早期休克类型,值得临床推广应用。Objective:To investigate the effect and feasibility of emergency doctors’application of critical ultrasound FALLS procedure in the early identification of shock types.Methods:From May 2018 to June 2020,210 shock patients in the emergency department of the Second Affiliated Hospital of Nanchang University were selected.On the premise of not delaying the treatment of these patients,the observation group was carried out bedside ultrasound exploration on these 210 patients by emergency doctors who have received intensive ultrasound training and qualified according to the FALLS process;while the control group were detected and measured by senior ultrasound doctors according to the conventional ultrasound process.Taking the final clinical diagnosis(symptoms,signs,history and auxiliary examinations)as the gold standard,the diagnostic time and diagnostic efficiency of different ultrasonic methods were compared and analyzed.Results:The average diagnosis time was(8.32±1.03)min in the observation group and(12.36±1.11)min in the control group.The diagnosis time in the observation group was significantly shorter than that in the control group(P<0.05).The sensitivity of the observation group to diagnose the type of shock was 100%,and the diagnostic sensitivity and positive predictive value of the observation group were higher than those of the control group(100.00%vs.91.46%,21.09%vs.3.91%,P<0.05).Further revealing the diagnostic efficacy of the two groups,the AUC of the diagnostic shock type in the observation group(0.851)was higher than that in the control group(0.575),and the difference was statistically significant(P<0.05).Conclusion:The critical ultrasound FALLS procedure is utilized by emergency physicians to examine shock patients,which contributes to quickly evaluating and defining the types of early shock,and promote its clinical application.

关 键 词：重症超声 FALLS流程 急诊科 休克 识别 

分 类 号：R«9.7[医药卫生]