床旁超声在基层ICU创伤患者气胸诊断中的价值分析

目的探讨临床医师应用床旁超声检查对严重创伤患者气胸进行评估并评价其效果，以求促进严重创伤救治水平的提高。方法纳入2015年1月1日至2017年6月20日连续创伤患者52例，对初入ICU的全部患者进行胸部超声检查。检查时患者平卧位，依次探查前胸、侧胸部，辨认并比较双侧的超声征象，以“肺滑行”和“彗尾征”均消失诊断为气胸。并在完成胸部超声后3h内完成胸部X线和CT检查，以CT或胸腔引流结果为“金标准”，评价超声诊断气胸的效果。结果52例患者中接受CT检查证实气胸10例12侧，其中超声诊断8例9例，X线片诊断5例5侧配对资料McNemar检验提示，超声与CT诊断的一致性较高，而X线片与CT的诊断比较差异有统计学意义（P〈0．05）。超声与X线对气胸的诊断在敏感性、阴性预测值、假阳性率及准确率方面比较差异有统计学意义（P均〈0．05）。结论床旁超声检查诊断ICU创伤患者气胸有较高的敏感性、特异性及准确性，具有重要的临床价值。

Objective To evaluate the effect of bedside ultrasound on pneumothorax in patients with severe trauma, in order to promote the improvement of severe trauma treatment. Methods A total of 52 consecutive trauma patients from January 1, 2015 to June 20, 2017 were enrolled in this study. All patients with initial ICU were examined by chest ultrasound. Patients were examined in the supine position, followed by the exploration of the chest, chest side, identification and comparison of ultrasonographic signs of bilateral, with ＂lung sliding＂ and ＂tail sign＂ disappeared in diagnosis ofpneumothorax. The chest X-ray and CT examination were performed within 3h after the completion of chest ultrasound. The results of CT or chest drainage were used as ＂gold standard＂ to evaluate the efficacy of ultrasound in the diagnosis ofpneumothorax. Results Of 52 cases, 10 cases of pneumothorax were confirmed by CT examination, including 12 sides in 10 cases, of which 8 cases were diagnosed by ultrasound and 9 sides, and 5 sides were diagnosed by X ray. Matching data McNemar test showed that ultrasound and CT diagnosis of the consistency was very high, and the difference of the X-ray and CT diagnosis was statistically significant （ P〈0.05 ） . The difference of the ultrasound and X-ray diagnosis of pneumothorax in the sensitivity, negative predictive value, false positive rate and accuracy was statistically significant （ P〈0.05 ） . Conclusion Bedside ultrasound diagnosis of ICU trauma patients with pneumothorax has a high sensitivity, specificity, accuracy and important chnical value.