超声对外伤引起胸腔内出血诊断价值的Meta分析

Diagnostic value of ultrasonography for thoracic cavity hemorrhage caused by chest trauma:a Meta-analysis

目的系统评价超声对外伤引起胸腔内出血的诊断价值。方法计算机检索The Cochrane Library、Pub Med、Science Citation Index、CNKI、CBM、VIP及Wan Fang数据库,查找关于超声对外伤引起胸腔内出血诊断价值的相关文献,检索时限均为建库至2017年5月8日。由两名评价者独立筛选文献并提取数据,纳入研究的方法学质量用采QUADAS质量评价工具评价;应用Meta-disc 1.4软件进行统计分析。结果最终纳入8项研究(2082例);Meta分析结果显示,超声对外伤引起的胸腔内出血诊断的敏感性、特异性、阴性似然比(-LR)、阳性似然比(+LR)、诊断比值比(DOR)及相应的95%可信区间分别为0.94(0.92~0.96)、0.99(0.98~0.99)、43.84(19.08~100.71)、0.10(0.01~1.85)、496.73(71.60~3446.26),综合受试者工作特征曲线下面积(SROC AUC)为0.9978。亚组分析提示,以胸腔置管引流/CT检查结果为金标准,超声诊断胸腔内出血的敏感性、特异性、-LR、+LR、DOR及相应的95%可信区间分别为0.99(0.97~0.99)、0.99(0.98~0.99)、6760.22(2406.59~18 989.75),SROC AUC为0.9978;以CT检查为金标准的诊断敏感性、特异性、DOR及相应的95%可信区间分别为0.74(0.64~0.83)、0.97(0.95~0.99)、64.07(10.64~385.82),SROC AUC为0.9869。结论胸部超声能准确判定外伤引起的胸腔内出血,可作为常规检查替代胸片或CT,值得临床推广使用。

Objective To systematically review the diagnostic value of ultrasonography for thoracic cavity hemorrhage caused by chest trauma.Methods Databases including the Cochrane Library,Pub Med,Science Citation Index,CNKI,CBM,VIP and Wan Fang were searched for diagnostic tests about chest ultrasongography for thoracic cavity hemorrhage caused by chest trauma from inception to May 8,2017.Two reviewers independently screened literature,extracted data and assessed the methodological quality of included studies by QUADAS tool.Meta-analysis was performed using Meta-Disc 1.4 software.Results A total of 8 studies involving 2082 patients were included.The results of Meta-analysis showed that Sen,Spe,＋LR,-LR,DOR and its 95% CI were 0.94（0.92 ~0.96）,0.99（0.98 ~0.99）,43.84（19.08 ~100.71）,0.10（0.01 ~1.85）,496.73（71.60 ~3446.26）,respectively,AUC was 0.9978.In the subgroup analysis,taken the results of thoracic drainage and CT as golden standard,the Sen,Spe,DOR and its 95%CI were 0.99（0.97~0.99）,0.99（0.98~0.99）,6760.22（2406.59~18 989.75）,respectively,AUC was 0.9978.Taken the results of CT as golden standard,the Sen,Spe,DOR and its 95%CI were 0.74（0.64~0.83）,0.97（0.95~0.99）and 64.07（10.64~385.82）,respectively,AUC was 0.9869.Conclusion The chest ultrasonography can accurately determine the intrathoracic bleeding.For the patients with pleural effusion or hemothorax,it is worthy to use ultrasonography to replace the chest X-ray and CT as a routine test.