ICU醫(yī)師應(yīng)用超聲診斷危重患者氣胸的價值研究.pdf
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[作者單位] 1.浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院急診科,浙江 杭州
310009 ; 2.浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院超聲醫(yī)學(xué)科; 3.杭州市
蕭山中醫(yī)院 ICU
[作者簡介] 張茂(1974 - ) ,男,博士研究生,主治醫(yī)師,從事急診創(chuàng)
傷與危重病的救治及研究。
ICU醫(yī)師應(yīng)用超聲診斷危重患者氣胸的價值研究
張 茂1
, 楊儉新1
, 干建新1
, 游向東2
, 劉志海1
, 高海霞3
, 江觀玉1
[摘 要] 目的 探討 ICU醫(yī)師應(yīng)用床旁超聲診斷危重患者氣胸的可行性及臨床價值。方法 2004 - 09～2005 - 07急
診 ICU收治101例危重患者 ,由 ICU醫(yī)師進(jìn)行床旁胸部超聲檢查 ,以“肺滑行”和“彗尾”征消失診斷氣胸。在超聲檢查前后 3 h
內(nèi)行胸部 CT和床旁 X片檢查 ,以 CT結(jié)果為“金標(biāo)準(zhǔn)”比較超聲和 X片診斷氣胸的價值。結(jié)果 101例危重患者中 ,CT確診氣
胸19例21側(cè) ,超聲診斷17例18側(cè) ,X片診斷4例4側(cè) ,相應(yīng)的診斷敏感性、特異性、陽性預(yù)測值、陰性預(yù)測值和準(zhǔn)確度分別為
85. 7 %對19. 0 %( P < 0. 001) 、 98. 9 %對100 %( P = 0. 499) 、 90. 0 %對100 %( P = 1. 0) 、 98. 4 %對 91. 4 %( P = 0. 002)和 97. 5 %
對91. 6 %( P = 0. 009) 。超聲與 CT診斷氣胸的一致性高于 X片。結(jié)論 ICU醫(yī)師完成的超聲檢查診斷氣胸具有較高的敏感
性和特異性 ,為危重患者氣胸的診斷提供了簡單、快速而安全有效的手段。
[關(guān)鍵詞] 氣胸; 超聲檢查; 危重患者
[中圖分類號] R 44511 [文獻(xiàn)標(biāo)識碼] A [文章編號] 1002 - 1949(2006) 02 - 0111 - 04
Study on the value of intensivist - performed ultrasonography to detect pneumothorax in critically ill patients ZHANG Mao , YANG
Jian - xin , GAN Jian - xin , et al . Department of Emergency , the 2 nd Aff iliated Hospital , Medical College of Zhejiang University , Hangzhou
310009 , China
[ Abstract] Objective To discuss the feasibility and value of intensivist - performed ultrasonography to detect pneumothorax in critically
ill patients. Methods It’ s a prospective , double - blinded and controlled study. From Sep 2004 to July 2005 , 101 critically ill patients admit 2
ted to emergency ICU were enrolled and bedside thoracic ultrasonography were performed by intensivists. Pneumothorax was diagnosed when the
two signs (lung - sliding and comet - tail) disappeared. Chest CT scan and bedside radiography were done within three hours. The result of CT
was regarded as a golden standard , and the value of ultrasonography and radiography were compared. Results In 101 cases , pneumothorax ex 2
isted in 21 hemithoraces of 19 patients by CT, in 18 hemithoraces of 17 patients by ultrasonography , but only 4 hemithoraces in 4 patients was
found by radiography. The corresponding data of sensitivity , specificity , positive predictive value , negative predictive value and accuracy by ul 2
trasonography and radiography were 85. 7 % vs 19. 0 % ( P < 0. 001) , 98. 9 % vs 100 %( P = 0. 499) , 90. 0 % vs 100 %( P = 1. 0) , 98. 4 %
vs 91. 4 %( P = 0. 002) and 97. 5 % vs 91. 6 %( P = 0. 009) . Consistency of the results between ultrasonography and CTwas higher than that
between radiography and CT. Conclusions Intensivist - performed ultrasonography has higher sensitivity and specificity in detecting pneumotho 2
rax , which supply easy , rapid ,safe and effective detection of pneumothorax in critically ill patients.
[ Key words] Pneumothorax ; Ultrasonography ; Critically ill patients
近年來 ,國外開始應(yīng)用超聲診斷氣胸[1～3 ]
,提示
對危重患者有較好的應(yīng)用前景 ,但作者尚未見國內(nèi)
相關(guān)的應(yīng)用報(bào)道。我們從 2004 - 09 開始 ,由 ICU 醫(yī)
師應(yīng)用超聲對本院急診 ICU( EICU)收治的 101 例危
重患者進(jìn)行檢查 ,并以床旁 X片和 CT為對照 ,探討
其對危重患者氣胸診斷的可行性與價值。
1 資料與方法
1. 1 資料 2004 - 09～2005 - 07本院 EICU收治的危
重患者,排除未能完成 CT檢查者,共計(jì) 101 例,其中
男86例,女15例;年齡9～78歲,平均46± 15歲。基
礎(chǔ)疾病構(gòu)成:以多發(fā)性創(chuàng)傷為主,共97例,其中57例
有明確的胸部外傷;嚴(yán)重肺部感染 2 例;腦血管意外
和急性CO中毒各1例。61例患者進(jìn)行機(jī)械通氣。
1. 2 方法 采用前瞻、雙盲對照研究。超聲檢查由
接受過專門胸部超聲技能培訓(xùn)的 ICU 醫(yī)師完成 ,通
常在下列情況下進(jìn)行: ①合并胸部創(chuàng)傷或機(jī)械通氣
患者初入 EICU ; ②作為 EICU 患者日常胸部評估的
內(nèi)容; ③患者發(fā)生呼吸功能突然惡化; ④臨床醫(yī)師懷
疑患者胸部有異常; ⑤患者因臨床需要行胸部 CT
檢查 ......
310009 ; 2.浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院超聲醫(yī)學(xué)科; 3.杭州市
蕭山中醫(yī)院 ICU
[作者簡介] 張茂(1974 - ) ,男,博士研究生,主治醫(yī)師,從事急診創(chuàng)
傷與危重病的救治及研究。
ICU醫(yī)師應(yīng)用超聲診斷危重患者氣胸的價值研究
張 茂1
, 楊儉新1
, 干建新1
, 游向東2
, 劉志海1
, 高海霞3
, 江觀玉1
[摘 要] 目的 探討 ICU醫(yī)師應(yīng)用床旁超聲診斷危重患者氣胸的可行性及臨床價值。方法 2004 - 09～2005 - 07急
診 ICU收治101例危重患者 ,由 ICU醫(yī)師進(jìn)行床旁胸部超聲檢查 ,以“肺滑行”和“彗尾”征消失診斷氣胸。在超聲檢查前后 3 h
內(nèi)行胸部 CT和床旁 X片檢查 ,以 CT結(jié)果為“金標(biāo)準(zhǔn)”比較超聲和 X片診斷氣胸的價值。結(jié)果 101例危重患者中 ,CT確診氣
胸19例21側(cè) ,超聲診斷17例18側(cè) ,X片診斷4例4側(cè) ,相應(yīng)的診斷敏感性、特異性、陽性預(yù)測值、陰性預(yù)測值和準(zhǔn)確度分別為
85. 7 %對19. 0 %( P < 0. 001) 、 98. 9 %對100 %( P = 0. 499) 、 90. 0 %對100 %( P = 1. 0) 、 98. 4 %對 91. 4 %( P = 0. 002)和 97. 5 %
對91. 6 %( P = 0. 009) 。超聲與 CT診斷氣胸的一致性高于 X片。結(jié)論 ICU醫(yī)師完成的超聲檢查診斷氣胸具有較高的敏感
性和特異性 ,為危重患者氣胸的診斷提供了簡單、快速而安全有效的手段。
[關(guān)鍵詞] 氣胸; 超聲檢查; 危重患者
[中圖分類號] R 44511 [文獻(xiàn)標(biāo)識碼] A [文章編號] 1002 - 1949(2006) 02 - 0111 - 04
Study on the value of intensivist - performed ultrasonography to detect pneumothorax in critically ill patients ZHANG Mao , YANG
Jian - xin , GAN Jian - xin , et al . Department of Emergency , the 2 nd Aff iliated Hospital , Medical College of Zhejiang University , Hangzhou
310009 , China
[ Abstract] Objective To discuss the feasibility and value of intensivist - performed ultrasonography to detect pneumothorax in critically
ill patients. Methods It’ s a prospective , double - blinded and controlled study. From Sep 2004 to July 2005 , 101 critically ill patients admit 2
ted to emergency ICU were enrolled and bedside thoracic ultrasonography were performed by intensivists. Pneumothorax was diagnosed when the
two signs (lung - sliding and comet - tail) disappeared. Chest CT scan and bedside radiography were done within three hours. The result of CT
was regarded as a golden standard , and the value of ultrasonography and radiography were compared. Results In 101 cases , pneumothorax ex 2
isted in 21 hemithoraces of 19 patients by CT, in 18 hemithoraces of 17 patients by ultrasonography , but only 4 hemithoraces in 4 patients was
found by radiography. The corresponding data of sensitivity , specificity , positive predictive value , negative predictive value and accuracy by ul 2
trasonography and radiography were 85. 7 % vs 19. 0 % ( P < 0. 001) , 98. 9 % vs 100 %( P = 0. 499) , 90. 0 % vs 100 %( P = 1. 0) , 98. 4 %
vs 91. 4 %( P = 0. 002) and 97. 5 % vs 91. 6 %( P = 0. 009) . Consistency of the results between ultrasonography and CTwas higher than that
between radiography and CT. Conclusions Intensivist - performed ultrasonography has higher sensitivity and specificity in detecting pneumotho 2
rax , which supply easy , rapid ,safe and effective detection of pneumothorax in critically ill patients.
[ Key words] Pneumothorax ; Ultrasonography ; Critically ill patients
近年來 ,國外開始應(yīng)用超聲診斷氣胸[1～3 ]
,提示
對危重患者有較好的應(yīng)用前景 ,但作者尚未見國內(nèi)
相關(guān)的應(yīng)用報(bào)道。我們從 2004 - 09 開始 ,由 ICU 醫(yī)
師應(yīng)用超聲對本院急診 ICU( EICU)收治的 101 例危
重患者進(jìn)行檢查 ,并以床旁 X片和 CT為對照 ,探討
其對危重患者氣胸診斷的可行性與價值。
1 資料與方法
1. 1 資料 2004 - 09～2005 - 07本院 EICU收治的危
重患者,排除未能完成 CT檢查者,共計(jì) 101 例,其中
男86例,女15例;年齡9～78歲,平均46± 15歲。基
礎(chǔ)疾病構(gòu)成:以多發(fā)性創(chuàng)傷為主,共97例,其中57例
有明確的胸部外傷;嚴(yán)重肺部感染 2 例;腦血管意外
和急性CO中毒各1例。61例患者進(jìn)行機(jī)械通氣。
1. 2 方法 采用前瞻、雙盲對照研究。超聲檢查由
接受過專門胸部超聲技能培訓(xùn)的 ICU 醫(yī)師完成 ,通
常在下列情況下進(jìn)行: ①合并胸部創(chuàng)傷或機(jī)械通氣
患者初入 EICU ; ②作為 EICU 患者日常胸部評估的
內(nèi)容; ③患者發(fā)生呼吸功能突然惡化; ④臨床醫(yī)師懷
疑患者胸部有異常; ⑤患者因臨床需要行胸部 CT
檢查 ......
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