创伤定点超声检查在战时创伤诊断中的应用研究

Application research of focused assessment by sonography of trauma in the diagnosis of wartime-trauma

目的:探讨创伤定点超声检查(focused assessment by sonography of trauma,FAST)在战时创伤诊断中的应用价值,以更好地指导临床治疗。方法:检索相关文献,分析FAST在平民创伤患者和战创伤伤员中的应用情况及其在军医中的培训效果。结果:FAST诊断胸腹部钝器伤的敏感性为0.74、特异性为0.96;诊断躯干部穿通伤的敏感性为0.28~1.00、特异性为0.94~1.00;诊断腹腔内创伤的敏感性为0.56~0.75、特异性为0.98~0.99。战时FAST可由非放射影像专业的军医完成,但至少需要进行25次的超声检查培训才能做出准确的判断。结论:FAST对创伤诊断的特异性很高,但敏感性较低。一经FAST确诊创伤,应尽早考虑手术治疗。然而,若FAST并未发现创伤,也不能轻易排除创伤的可能性,则需考虑行CT等检查,进一步评估伤情。

Objective:To evaluate the clinical value of focused assessment by sonography of trauma(FAST)in the diagnosis of wartime-trauma,in order to better guide the clinical treatment.Methods:All relevant papers were systematically searched,information about application of FAST in civilian injuries and combat casualties,and training effect of FAST for military doctors were analyzed.Results:The sensitivity and specificity of FAST for diagnosing thoracoabdominal injuries was 0.74 and 0.96,respectively.And those of FAST for diagnosing penetrating torso trauma was 0.94-1.00 and 0.28-1.00,respectively.And those of FAST for diagnosing intra-abdo minal trauma was 0.56-0.75 and 0.98-0.99,respectively.FAST examination could be performed by military doctors who were not radiologists during wartime,but they can not make any accurate diagnosis until at least 25 ultrasound trainings of FAST have been completed.Conclusion:FAST has a high specificity for diagnosing injury,but a relatively low sensitivity.Once injury is confirmed by FAST,surgery would be performed as soon as possible.However,if there is no remarkable evidence of injury shown by FAST,military doctors should not completely exclude any possibility of injury,CT examination is performed for further assessment of the injury.