改良重症超声快速管理方案在休克患者病因诊断中的作用  

Evaluating value of modified critical care ultrasonic examination scheme for the etiological diagnosis of various shock in ICU patients

作　　者：张雪艳[1] 李志峰 王海波[1] 秦秉玉[1] 代荣钦[1] Zhang Xueyan;Li Zhifeng;Wang Haibo;Qin Bingyu;Dai Rongqin(Intensive Care Unit of Henan Province People's Hospital,Zhengzhou,450003,China)

机构地区：[1]河南省人民医院重症医学科,郑州450000

出　　处：《中华急诊医学杂志》2022年第7期952-956,共5页Chinese Journal of Emergency Medicine

基　　金：2020年河南省医学适宜技术推广项目(SYJS2020050)。

摘　　要：目的探讨改良重症超声快速管理(modified critical care ultrasonic examination,M-CCUE)方案在各类休克患者病因诊断中的作用。方法前瞻性研究收集2020-05-01至2021-08-31期间在河南省人民医院重症医学科收治的各类休克患者的相关临床资料,包括血流动力学指标、器官及组织灌注和预后评价指标。所有入选患者在入室30 min内完成初始M-CCUE评估,根据M-CCUE评分系统予以评分(M-CCUE score,MCS),分析相关数据结果。结果93例符合入选和排除标准的患者纳入本研究,其中2例因入室后立刻行抢救治疗而未完成M-CCUE的评估,5例因两位医师对超声判断不一致予以剔除,最终共86例患者入组。M-CCUE方案对休克患者病因诊断的初步诊断时间为(13.02±3.15)min,确定诊断时间(67.70±20.20)min,初始诊断正确率83.7%,其中分布性休克占60.4%,低血容量性休克占25.6%,心源性休克及梗阻性休克均占3.5%,混合型休克占7%;MCS为(13.27±4.91)分,M-CCUE方案对分布性休克敏感度为91.2%、特异度为96.6%,低血容量性休克敏感度为96.0%、特异度为96.7%,心源性休克敏感度为85.7%、特异度为98.7%,梗阻性休克敏感度为60.0%、特异度为100%;MCS与APACHE Ⅱ评分具有良好正相关性(r=0.861,P<0.001),与ICU费用无相关性(r=0.012,P=0.915),28 d病死率两组MCS差异无统计学意义(P=0.391)。结论针对入住ICU病因不明的休克患者,M-CCUE方案对病因的初步诊断需时较短,具有较高的正确诊断率、敏感度和特异度,且其量化评估结果可预测患者的危重程度。Objective The purpose of this study was to investigate the evaluating value of modified critical care ultrasonic examination(M-CCUE)scheme for the etiological diagnosis of shock in ICU patients.Methods The prospective study collected relevant clinical data of various shock patients admitted to the Department of Intensive Care Medicine,Henan Provincial People's Hospital from May 2020 to July 2021,including hemodynamic、blood indicatorsorgan/tissue perfiision and prognostic evaluation indicators.All selected patients completed the initial M-CCUE assessment within 30 minutes,were scored according to the M-CCUE score system and related data results were analyzed.Results Ninety-three patients were included in this study,Two of them were not completed the M-CCUE assessment due to emergency treatment immediately after entering our department,and five were excluded due to inconsistent ultrasound judgments by the two physicians.In the end,a total of 86 patients were enrolled in the group.In patients applied with M-CCUE scheme,time to preliminary diagnosis and final diagnosis were(13.02±3.15)min and(67.70±20.20)min respectively,the accuracy of diagnosis was 83.7%.Among them,distributed shock accounted for 60.4%,hypovolemic shock accounted for 25.6%,cardiogenic shock and obstnuctive shock sccounted for 3.5%,and mixed shock accounted for 7%;MCS is(13.27±4.91),M-CCUE scheme had the high sesitivity and pepifcitt for the diagnosis of dstibuted shok(stivitit 91.2%,seiti 93.9%),byprolemie shock(csivitit 96.0%,spici 96.7%),cardiogenie shock(ensitivity 85.7%,seifcit 98.7%)and obstuctive shock(scsitivity 60.0%,spcicit 100%);MCS has a good positive creation with APACHE II score(r=0.861,P<0.001),and has no corelation with ICU cost(r=0.012,P=0.915).There is no sgicant diferenme in MCS between.the 28d death group and the rcoverey group(P=0.391).Conclusions For sock patients adited to ICU with unkown ciology,the itiai diagnosis of the couse of tbe M.CCUE prognm takes less time,has a higbher core dignosis rate,sisivit and pcifcie,and

关 键 词：重症超声 M-CCUE方案 休克 病因评估 

分 类 号：R459.7[医药卫生—急诊医学]