Duvall W Lane, Croft Lori B, Goldman Martin E
The Zena and Michael Weiner Cardiovascular Institute, Mount Sinai Medical Center, New York, New York 10029, USA.
Echocardiography. 2003 Jul;20(5):471-6. doi: 10.1046/j.1540-8175.2003.03070.x.
Echocardiography (echo) is a powerful, noninvasive, inexpensive diagnostic imaging technique that provides important information in a variety of cardiovascular diseases. Echo provides rapid information regarding ventricular and valvular function in the clinical management of patients. Smaller, relatively inexpensive hand-carried cardiac ultrasound (HCU) devices have become commercially available, which can be used for diagnostic cardiac imaging. Because of their relative ease of use, portability, and affordable cost, these new hand-held systems have made point-of-care (bedside) echocardiography available to all medical personnel. The rate-limiting step to the widespread use of this technology is the lack of personnel with echo training at the immediate contact point with patients. Although extensive training and experience are needed to acquire and interpret a complete echo, training medical personnel to perform and interpret a limited echo (defined as a brief, diagnosis focused exam) may fully exploit the potential of echo as a point-of-care diagnostic tool and may be accomplished in a short period of time. Presently there are guidelines for independent competency in echocardiography and HCU echo established by several professional organizations and as a result of these rigorous guidelines, other noncardiology medical professionals who could practically derive the greatest benefit are discouraged and virtually precluded from utilizing echo during the initial encounter with the patient. However, there is now a growing body of literature in a diverse group of noncardiology medical personnel that demonstrates that it is possible to quickly and effectively train them to perform and interpret limited echocardiograms. Medical students, medical residents, cardiology fellows with limited experience, emergency department physicians, and surgical intensive care unit staff have all been evaluated after only brief, focused training periods, and investigators found that HCU echo provided important new information, changed therapeutic management, and was vastly superior to the physical exam alone with an acceptable overall level of accuracy. The contribution of echocardiography to the field of cardiovascular disease since its invention has been significant and the newer compact, portable, ultrasound systems have the potential to revolutionize the utilization and availability of echocardiography. To maximize integration of echo into medical practice, physicians and physician extenders could be trained to perform and interpret limited echo to complement their clinical examination and improve their diagnostic skills. The challenge is to provide practical training programs to assure competency in performing point of care echocardiograms.
超声心动图（echo）是一种强大、无创且经济的诊断成像技术，可在多种心血管疾病中提供重要信息。在患者的临床管理中，超声心动图能快速提供有关心室和瓣膜功能的信息。体积更小、相对便宜的手持式心脏超声（HCU）设备已投入商业使用，可用于心脏诊断成像。由于其使用相对简便、便于携带且成本可承受，这些新型手持式系统使所有医务人员都能进行床旁即时超声心动图检查。该技术广泛应用的限速步骤是在与患者直接接触的层面缺乏接受过超声心动图培训的人员。虽然获取和解读完整的超声心动图需要广泛的培训和经验，但培训医务人员进行和解读有限的超声心动图（定义为简短的、以诊断为重点的检查）可能会充分发挥超声心动图作为床旁诊断工具的潜力，并且可以在短时间内完成。目前，几个专业组织已制定了超声心动图和HCU超声心动图独立能力的指南，由于这些严格的指南，其他实际上能从中获益最大的非心脏病学医学专业人员在初次接触患者时被劝阻甚至几乎被排除在使用超声心动图之外。然而，现在越来越多针对不同非心脏病学医学人员群体的文献表明，有可能快速有效地培训他们进行和解读有限的超声心动图。仅经过简短的重点培训期后，对医学生、住院医师、经验有限的心脏病学研究员、急诊科医生和外科重症监护病房工作人员都进行了评估，研究人员发现HCU超声心动图提供了重要的新信息，改变了治疗管理，并且在总体准确性可接受的情况下，远优于单纯的体格检查。自发明以来，超声心动图对心血管疾病领域的贡献巨大，而更新的紧凑型、便携式超声系统有可能彻底改变超声心动图的应用和可及性。为了最大限度地将超声心动图整合到医疗实践中，可以培训医生和医生助理进行和解读有限的超声心动图，以补充他们的临床检查并提高诊断技能。挑战在于提供实用的培训项目，以确保具备进行床旁超声心动图检查的能力。
