创伤重点超声评估法(FAST)在胸腹外伤急救中的应用

Application of focused assessment of sonography for trauma in the early screening of the wounded in eergency department

目的分析我院急诊科床边超声急诊筛查伤员胸腹部损伤情况,探讨创伤重点超声评估法(FAST)在急诊创伤救治早期的运用价值。方法急诊科以胸腹外伤收治患者共324例接受了胸腹部超声检查,均采用创伤重点超声评估法(FAST)。结果有58例伤员超声提示创伤性腹腔积液,其中32例伤员超声提示了内脏损伤部位,30例超声定位正确,2例与术中探查损伤部位不符;4例患者超声提示血气胸,2例超声提示气胸可能,经胸部CT检查及胸腔闭式引流证实。FAST检查经证实的假阴性3例,术前及治疗中均未出现大量腹腔积液。结论便携式超声FAST具有便捷性、无环境限制、不需移动伤员、可与急救或专科检查同步进行等优点,对于需紧急手术的腹部闭合损伤患者敏感性为94.9%,是创伤早期最为重要的胸腹部闭合性损伤的筛查方法,但其不能作为腹部损伤的最终检查。

Objective To analyze the ultrasound screening of abdominal injuries of the wounded and to explore the application of Focused Assessment of Sonography for Trauma（FAST）in early rescue of emergency.To analyze the ultrasound screening of abdominal injuries of the wounded and to explore the application of Focused Assessment of Sonography for Trauma（FAST）in early rescue of emergency.Methods In tota1,324 wounded received ultrasound examination of abdomen and FAST was applied.Results Ultrasound examination indicated that 58 cases had traumatic ascites,56 of which were later confirmed by emergency operation or peritoneocentesis.Of the 56 cases,the visceral injury was indicated by ultrasound examination in 39 cases;the visceral injury location of 30 cases was correctly indicated and 2 cases were not by ultrasound examination.The Ultrasound examination indicated that 4 cases had hemopneumothorax and 2 cases had pneumothorax,which were confirmed by chest CT and thoracic close drainage.Three cases examined by FAST were confirmed to be false negative because that traumatic ascites had not appeared pre-and intra-operation.Conclusion FAST is of such advantages as convenient,portable,no environmental limitations,no need to move the wounded.It is 94.9% sensitive to closed abdominal trauma which needs emergency operation.FAST is the most important screening method for closed abdominal trauma in the early rescue,though it could not be the final examination.