ICU医师应用床旁超声快速诊断多发伤合并血胸的临床价值

The Clinical Value of ICU Medical Application of Bedside Ultrasound Diagnosis in Patients with Multiple Trauma Hemothorax

目的:探讨ICU医师应用床旁超声快速诊断多发伤合并血胸患者的可行性及临床价值,评价床旁超声在诊断及治疗决策中的优势。方法:对本院2015年7月-2016年8月ICU收治的73例多发伤合并血胸患者,全部患者均由经过专业培训的ICU医师进行胸部床旁超声检查。在床旁超声检查后2 h内,同时在病情允许下完成胸部CT及X线片检查,73例患者中有66例完成全部检查。以胸部CT检查的结果作为金标准,比较床旁超声和胸部X线片诊断创伤性血胸的临床价值。结果:66例多发伤合并血胸患者中,CT确诊血胸13例15侧,床旁超声诊断12例13侧,X线片诊断3例3侧。X线片与床旁超声的诊断比较差异有统计学意义(P<0.05)。由ICU医师应用床旁超声进行快速诊断所需的时间最短,X线片需要的时间最长,ICU医师床旁超声的检查耗时均短于胸部CT和X线片,差异均有统计学意义(P<0.01)。结论:经过专业培训的ICU医师对床旁超声检查更具优势,应用床旁超声进行快速诊断的标准更符合医学上的金标准,对严重多发伤合并血胸患者的早期快速诊断和抢救治疗具有重要的意义,值得在临床应用和推广。

Objective： To explore the application of bedside ultrasound physician ICU rapid diagnostic feasibility and clinical value of multiple trauma patients with hemothorax, advantage evaluation of bedside ultrasound in diagnosis and treatment.Method： In our hospital from July 2015 to August 2016 ICU treated 73 cases of multiple trauma with hemothorax, all patients were performed chest bedside ultrasonography by trained physicians ICU.CT and X-ray examination were performed at the same time in 2 h after bedside ultrasound examination, 73 cases of 66 patients completed all the examination.The chest CT examination results as the gold standard, comparison of bedside ultrasound and chest X-ray diagnosis of traumatic hemothorax and the clinical value.Result： 66 patients with multiple injuries combined with hemathorax, CT diagnosis of hemothorax in 13 cases 15 sides, bedside ultrasound diagnosis of 12 cases of the 13 side, X-ray diagnosis of 3 cases with 3 sides, there was significant difference in the diagnosis of X-ray and bedside ultrasound （ P〈0.05 ） .ICU doctor by the application of bedside ultrasound to diagnosis of the shortest time, X-ray needed the most time, ICU doctor bedside ultrasound examination time was shorter than those in chest CT and X-ray, the differences were statistically significant （P〈0.01） .Conclusion： The professional training of ICU physician has more advantages on bedside uhrasonography, application of bedside ultrasound rapid diagnosis standards more in line with the gold standard of medicine, has the vital significance to the severe multiple injury and early hemothorax patients rapid diagnosis and emergency treatment, it is worthy of clinical application.