急诊科医生主导的床旁超声技术在创伤救治中的作用

Effect of bedside ultrasound performed by emergency physician on the trauma patients

目的 探讨急诊医生主导的床旁超声技术在多发创伤中的作用。方法119例创伤患者分为急诊超声组（A组）和对照组（B组），A组63例由急诊科医生进行创伤超声重点评估，B组56例由超声科医生进行床旁常规超声检查，比较两组超声检查的准确率，并记录完成超声检查距人院的时间，A组中的42例患者在超声引导下进行颈内静脉穿刺，B组中的39例患者采用常规体表定位法进行颈内静脉穿刺，比较两组的一次进针成功率、总成功率、并发症发生率、穿刺时间等。结果与B组比较，A组能在入院后更短的时间内完成超声检查（P〈0．01），两组的超声检查准确率均为100％，A组在超声引导下进行颈内静脉穿刺的一次进针成功率、总成功率明显高于B组（P〈0．05），而并发症发生率、穿刺所用时间明显少于B组（P〈0．05）。结论急诊科医生主导进行的急诊床旁超声技术，在创伤病情评估、中心静脉穿刺等方面有巨大的优势，有助于创伤患者的救治，应该在急诊科推广应用。

Objective To investigate the value of bedside ultrasound used by emergency physician in trauma patients. Methods 119 trauma patients in our the emergency department were divided into emergency ultrasound group（A group） and control group（B group）. Focused assessment with sonography for the trauma （FAST ） was performed by emergency physician in sixty -three multiple traumatic patients of A group. Conventional ultrasound examination was performed by ultrasound specialist in fifty - six patients of B group. Accuracy rate of ultrasound examination and the time from admission to ul- trasound evaluation were recorded. 42 patients in A group accepted two -dimensional ultrasound - guided internal jugular vein cannulation. External landmark - guided technique was used in thirty - nine patients of B group during internal jugular vein cannulation. The success rate of first attempt, total success rate, complication rate and average access time were recorded. Results Compared with B group, ultrasound examinations were completed more quickly in A group（ P 〈 0.01 ）, the accuracy rates of ultrasound examination were 100% in both groups , the success rate of first attempt and total success rate of internal jugular vein cannulation were higher in A group （ P 〈 0.05）, the complication rate and the avrage access time were less in A group （ P 〈 0.05 ）. Conclusion Emergency physician performed bedside ultrasound, which is beneficial to the assessment of trauma and central line placement. It is helpful to save the lives of trauma patients and should be widely used in the department of emergency medicine.