在ICU应用超声诊断危重病人气胸的临床评价

Study on Value of Ultrasonography in Detection of Pneumothrax for Critically Ill Patients in ICU

目的探讨在ICU应用床旁超声诊断危重病人气胸的临床效果。方法2005年9月—2006年7月ICU收治95例危重病人,进行床旁胸部超声检查,以“肺滑行”和“彗尾”征消失诊断气胸。在超声检查前后3h内行胸部CT和床旁X片检查,以CT结果为“标准”比较超声和X片诊断气胸的价值。结果95例危重病人中,CT确诊气胸24例27侧,超声诊断21例23侧,X片诊断5例5侧,相应的诊断敏感性、特异性、阳性预测值、阴性预测值和准确度分别为85.1%对18.5%(P<0.001),98.8%对100%(P=0.489),92.0%对100%(P=1.0),97.6%对88.1%(P=0.002)和96.8%对88.4%(P=0.009)。超声与CT诊断气胸的一致性高于X片。结论在ICU应用超声检查诊断气胸具有较高的敏感性和特异性,为危重病人气胸的诊断提供了简单、快速而安全有效的手段。

Objective To discuss the feasibility and the value of uhrasonography for the detection of pneumothorax in critically ill patients in ICU. Methods It＇s a prospective, double-blinded and controlled study, From Sep. 2005 to Jul. 2006, 95 critically ill patients admitted to emergency ICU were enrolled, and bedside thoracic ultrasonography was performed. Pneumothorax was diagnosed when the signs measured up to standard. Chest CT scan and bedside radiography were done within three hours. The result of CT was regarded as a golden standard, and the values of ultrasonography and radiography were compared with it. Results In the 95 cases, pneumothorax existed in 27 beret-thoraces of 24 patients by CT, in 23 hemi-thoraces of 24 patients by uhrasonography, and only in five hemi-thoraces of four patients by radiography. The corresponding data of sensitivity, specificity, positive predictive value, negative predictive value and accuracy by ultrasonography vs radiography were 85.1% vs 18.5% （ P 〈 0.001 ）, 98.8% vs 100% （P=0.489）,92.0% vs100%（P=1.0）,97.6% vs88.1% （P=0.002） and 96.8% vs88.4% （P=0.009）.Consistency of the results between ultrasonography and CT was higher than that between radiography and CT. Conclusion Uhrasonography has higher sensitivity and specificity in the detection of pneumothorax in ICU, and it acts as an easy, rapid, safe and effective detection of pneumothorax for critically ill patients.