Abrams B J, Sukumvanich P, Seibel R, Moscati R, Jehle D
Department of Emergency Medicine, SUNY at Buffalo Erie County Medical Center, NY 14215, USA.
Am J Emerg Med. 1999 Mar;17(2):117-20. doi: 10.1016/s0735-6757(99)90040-2.
A prospective, observational study was performed to evaluate the role of Trendelenburg positioning in improving the sensitivity of the single-view ultrasound examination. Hemodynamically stable patients undergoing diagnostic peritoneal lavage (DPL) were assigned to one of two groups: supine or 5 degrees of Trendelenburg positioning. Baseline right intercostal oblique images of Morison's pouch were obtained followed by additional images for each 100 cc of lavage fluid instilled into the peritoneal cavity. The initial volume of fluid required to identify an anechoic stripe was recorded for each patient. Patients were excluded if they had (1) a positive DPL for hemoperitoneum (defined as 10 cc of gross blood or >100,000 red blood cells/microL), (2) positive baseline ultrasound study, (3) hemodynamic instability, or (4) lack of documentation (ie, baseline/subsequent hard copy images were not obtained or inadequately demonstrated anechoic stripe). The mean quantity of fluid for visualization of the anechoic stripe was 443.8 cc in the Trendelenburg group (n = 8) and 668.2 cc in the supine group (n = 11). These means were statistically different (P < .05, t test). The median amount of fluid needed for visualization of the anechoic stripe was 400 cc and 700 cc for the Trendelenburg and supine groups, respectively.
进行了一项前瞻性观察性研究，以评估头低脚高位在提高单视图超声检查敏感性方面的作用。接受诊断性腹腔灌洗（DPL）且血流动力学稳定的患者被分为两组之一：仰卧位或头低脚高位5度。获取莫里森陷凹的基线右肋间斜位图像，然后在向腹腔内注入每100 cc灌洗液后获取额外图像。记录每位患者识别无回声带所需的初始液体量。如果患者有以下情况则被排除：（1）腹腔灌洗发现腹腔积血阳性（定义为肉眼可见10 cc血液或>100,000个红细胞/微升），（2）超声检查基线阳性，（3）血流动力学不稳定，或（4）缺乏记录（即未获得基线/后续硬拷贝图像或未充分显示无回声带）。头低脚高位组（n = 8）识别无回声带的平均液体量为443.8 cc，仰卧位组（n = 11）为668.2 cc。这些平均值在统计学上有差异（P <.05，t检验）。头低脚高位组和仰卧位组识别无回声带所需的液体量中位数分别为400 cc和700 cc。
