经腹部B超诊断对腹部实质脏器闭合性损伤患者诊断结果及预后的影响

Effect of Transabdominal Ultrasound on the Diagnosis and Prognosis of Patients with Blunt Abdominal Trauma

目的研究经腹部B超对腹部实质脏器闭合性损伤(BAT)患者诊断结果及预后的影响。方法以2019年6月-2023年6月樟树市第二人民医院收治的58例BAT患者为研究对象,均经腹部B超检查,以后续手术结果为金标准,分析经腹部B超对BAT的诊断效能(诊断敏感度、特异度、准确性),并统计经腹部B超与手术对不同内脏损伤的诊断一致性,比较不同下腔静脉呼吸塌陷指数(IVC-CI)患者的休克发生情况,采用受试者工作特征曲线(ROC)分析经腹部B超对BAT并发休克的预测价值。结果经腹部B超对BAT的诊断敏感度为93.33%,特异度为84.62%,准确性为91.38%。Kappa检验显示,经腹部B超与手术对不同内脏损伤的诊断一致性良好(Kappa=0.624,P<0.05)。IVC-CI≥50%患者的休克发生率高于IVC-CI<50%患者(χ^(2)=8.605,P<0.05)。ROC曲线显示,经腹部B超对BAT并发休克具有确切预测价值(AUC=0.825,P<0.05)。结论经腹部B超对BAT具有确切诊断价值,其结果与手术具有良好的一致性,对BAT并发休克具较高的预测作用。

Objective To study the effect of transabdominal ultrasound on the diagnosis and prognosis of patients with blunt abdominal trauma(BAT).Methods A total of 58 patients with BAT admitted to Zhangshu Second People's Hospital from June 2019 to June 2023 were examined by transabdominal ultrasound.The results of follow-up surgery were used as the gold standard to analyze the diagnostic efficacy(diagnostic sensitivity,specificity and accuracy)of transabdominal ultrasound for BAT.The diagnostic consistency of transabdominal ultrasound and surgery for different visceral injuries was statistically analyzed.The occurrence of shock in patients with different inferior vena cava respiratory collapse index(IVC-CI)was compared.The receiver operating characteristic curve(ROC)was used to analyze the predictive value of transabdominal ultrasound for BAT complicated with shock.Results The diagnostic sensitivity of transabdominal ultrasound for BAT was 93.33%,the specificity was 84.62%,and the accuracy was 91.38%.Kappa test showed that transabdominal ultrasound and surgery had good consistency in the diagnosis of different visceral injuries(Kappa=0.624,P<0.05).The incidence of shock in patients with IVC-CI≥50%was higher than that in patients with IVC-CI<50%(χ^(2)=8.605,P<0.05).ROC curve showed that transabdominal ultrasound had a definite predictive value for BAT complicated with shock(AUC=0.825,P<0.05).Conclusion Transabdominal ultrasound has a definite diagnostic value for BAT,and its results are in good agreement with those of surgery.It has a high predictive effect on BAT complicated with shock.