Hoffmann R, Nerlich M, Muggia-Sullam M, Pohlemann T, Wippermann B, Regel G, Tscherne H
Department of Trauma Surgery, Hannover Medical School, Federal Republic of Germany.
J Trauma. 1992 Apr;32(4):452-8. doi: 10.1097/00005373-199204000-00008.
Early recognition of blunt abdominal trauma in patients with multiple injuries and in shock is of utmost importance and calls for a rapid screening method. The reliability of diagnostic ultrasonography in detecting hemoperitoneum in patients with multiple trauma was evaluated prospectively. From 1986 to 1990, 291 patients with severe multiple injuries (ISS greater than 20, mean ISS 31.2) were included in the study. Laparotomy was performed on 117 patients (40%). Initial ultrasound (US) findings showed a sensitivity, specificity, and accuracy of 89%, 97%, and 94%, respectively, in detecting intra-abdominal injuries requiring surgical repair. The positive and negative predictive values were 94% and 95%, respectively. A standardized management of frequent repeat US studies can even improve on these numbers. In our department ultrasonography has replaced diagnostic peritoneal lavage (DPL) as the diagnostic study of first choice. Diagnostic peritoneal lavage is reserved for selected cases only.
早期识别多发伤和休克患者的钝性腹部创伤至关重要，需要一种快速筛查方法。前瞻性评估了诊断性超声检查在检测多发伤患者腹腔积血方面的可靠性。1986年至1990年，291例严重多发伤患者（损伤严重度评分大于20，平均损伤严重度评分为31.2）纳入研究。117例患者（40%）接受了剖腹手术。初始超声（US）检查结果显示，在检测需要手术修复的腹腔内损伤方面，敏感性、特异性和准确性分别为89%、97%和94%。阳性和阴性预测值分别为94%和95%。对频繁重复超声检查进行标准化管理甚至可以提高这些数值。在我们科室，超声检查已取代诊断性腹腔灌洗（DPL）成为首选诊断方法。诊断性腹腔灌洗仅保留用于特定病例。
