床旁超声在重症监护治疗决策中的价值探讨

The Value of Bedside Ultrasound in Improving Treatment in ICU

目的探讨床旁超声在重症监护治疗决策中的价值及应用方案。方法回顾2010年6月-2012年2月期间床旁超声应用情况及提供的信息对治疗决策的影响及临床效果,总结重症诊治临床实践中可行的应用方案。结果研究期间共使用床旁超声219例次,其中血流动力学监测(评估心脏前负荷、收缩力)41例次,低氧原因检查45例次,血栓筛查19例次,胎心监测22例次,引导深静脉穿刺48例次,引导胸、腹腔穿刺及置管37例次,引导动脉置管4例次,气道情况检查3例次。循环监测中经验判断容量准确性为63.4%,床旁超声能提供85.4%的正确信息,其中纠正了13例临床经验判断错误(31.7%),明显提高了诊断正确率(P<0.05);低氧原因判断中临床判断正确率62.2%,超声检查能提供86.7%的正确信息,发现16例临床经验判断错误,纠正错误判断35.6%(P<0.05)。结论床旁超声能很好地协助重症医学科医生提高临床判断准确性,控制医疗风险。

Objective To investigate the value of bedside ultrasound in improving treatment in ICU,and to make a feasible protocol.Methods The utilization and effect on treatment of bedside ultrasound in ICU between June 2010 and February 2012 were retrospectively analyzed.At the same time,related literatures were reviewed to summarize a feasible protocol.Results The bedside ultrasound were totally used 219 times,including hemodynamic monitoring for 41 times,investigating hypoxia reasons for 45 times,screening thrombosis for 19 times,fetal heart monitoring for 22 times,guiding venous puncture for 48 times,thoracentesis and abdominal paracentesis for 37 times,artery catheterizing for 4 times,and airway examination for 3 times,respectively.In hemodynamic monitoring,the accuracy of judging by experience was 63.4%,but by bedside ultrasound was 85.4%.It significantly improved the diagnostic accuracy through correcting 31.7% wrong judgment by experience（P〈0.05）.In hypoxia,the accuracy by clinical judgment was 62.2%,but was 86.7% by ultrasound.It corrected 35.6% wrong judgment（P〈0.05）.Conclusion Bedside ultrasound may help doctors in ICU to improve diagnostic accuracy and decrease the risk of incorrect treatment.