重症超声在基层重症病房临床诊断中的应用价值研究

The application value of critical ultrasound in clinical diagnosis in intensive care unit of basic level hospitals

目的探讨重症超声在基层重症病房中临床诊断的应用价值。方法对既往没有学习过重症超声的市级中心医院重症医学科一线医务人员进行短期超声培训,根据其临床情况自主决定并使用重症超声对患者进行入科检查及临床问题导向检查。记录重症超声的使用情况及发现的超声征象、能否为临床诊治提供帮助,分析统计超声提供的有用信息和不同使用方式下对确立诊断的作用。比较流程化与非流程化检查对于临床诊断的有用性。结果研究期间共行床旁超声检查56例次。可提供有用临床信息49例次(87.5%),其中进行重症急会诊超声检查(CCUE)方案化检查21例次(21/49),单项问题导向重点检查28例次(28/49)。帮助确立诊断23例次。使用CCUE、腹腔出血创伤评估(FAST)流程化检查者有15例次帮助确立诊断,而非流程化检查只有8例次帮助确立诊断,流程化检查较非流程化检查能明显有助于诊断(P=0.003)。结论通过简短的培训后,重症超声可以在基层医院快速掌握后应用于临床诊断工作中,对临床快速诊断和治疗提供很大的帮助;流程化检查比非流程化检查更能提供帮助,需要加强培训。

Objective To explore the application value of the clinical diagnose of critical ultrasound in ICU of basic levels hospitas. Methods We trained medical staffs who have not studied critical ultrasound in a municipal central hospital for short time. Then, these medical staffs performed the entry examinations for patients and the clinical problem oriented examinations in ICU according to the clinical situation. They recorded the process of critical ultrasound and ultrasonic signs of patients. At the same time, the medical staffs judged whether ultrasound was helpful for clinical diagnosis and treatments. Finally, by analyzing the useful information provided by statistics data of ultrasound, they evaluated the role of uhrasonography in the diagnosis of diseases. Results＇ After the short term training for the first-line doctors, 56 cases of bedside ultrasound examination had been performed. The useful clinical cases are 49 （87.5%）, in which 21 cases had been examined by CCUE program,28 cases had single problem oriented focus on examination and23 cases were diagnosed by ultrasound. By using processized CCUE and FAST examination, 15 patients were helped to establis diagnose while only 8 cases were helped to establish the diagnosis by non-processized examination. Thus, the processized examination was more helpful than the non-processized examination for ultrasound diagnosis （P = 0. 003）. Conclusion The critical ultrasound can be ap- plied to basic level hospitals after short time training. It can provide a great h^lp to fast diagnosis and treatment. Further, the processized inspection is more helpful than non-processized inspection. Therefore,the medical staff need to be trained intensively.