Piccoli Mara, Trambaiolo Paolo, Salustri Alessandro, Cerquetani Elena, Posteraro Alfredo, Pastena Guglielmo, Amici Elisabetta, Papetti Federica, Marincola Edoardo, La Carruba Salvatore, Gambelli Giancarlo
Department of Cardiology, Presidio Ospedaliero Integrato Portuense, Rome, Italy.
Chest. 2005 Nov;128(5):3413-20. doi: 10.1378/chest.128.5.3413.
The aim of this study was to assess the potential value of hand-carried ultrasound (HCU) devices in the diagnosis and follow-up of patients with pleural effusion (PE) after cardiac surgery.
Seventy consecutive patients were evaluated at bedside early after cardiac surgery, in the upright sitting position, using an HCU device on hospital admission and every 3 days until hospital discharge. The posterior chest wall was scanned along the paravertebral, scapular, and posterior axillary lines. For each hemithorax, an effusion index was derived as the sum of the intercostal spaces between the lower and upper limits of the PE along the lines of scanning, divided by 3. A standard chest radiograph was performed in all patients on hospital admission and at hospital discharge, and was qualitatively scored (0, absent; 1, small; 2, large PE). The findings of the HCU device and radiograph were compared using kappa statistics and the Kruskal-Wallis test.
A chest ultrasound was feasible in all patients (mean [+/- SD] time, 5 +/- 2 min). Compared with the chest ultrasound, a physical examination showed a sensitivity of 69% and a specificity of 77%. On hospital admission, the HCU device detected a PE in 72 of 140 hemithoraxes. Agreement with the finding of the radiograph was 76% (kappa = 0.52). In 15 hemithoraxes, the HCU device revealed a PE that had not been diagnosed using the radiograph. Conversely, in 18 hemithoraxes a PE that had been diagnosed with a radiograph was not confirmed by the HCU device. The correlation between ultrasound and radiographic scores was statistically significant (p < 0.001). At hospital discharge, a PE was present in 31 of 140 hemithoraxes according to the findings of the HCU device, and in 38 of 140 hemithoraxes according to the findings of the radiograph (agreement, 78%; kappa = 0.44).
In patients early after cardiac surgery, HCU devices allow rapid PE detection and improve the clinical diagnosis. Compared to a radiograph, this method offers the unique advantage of the bedside evaluation of patients without the need for radiation exposure.
本研究旨在评估手持式超声（HCU）设备在心脏手术后胸腔积液（PE）患者诊断及随访中的潜在价值。
连续70例患者在心脏手术后早期于床边进行评估，取直立坐位，入院时及直至出院每3天使用HCU设备一次。沿椎旁线、肩胛线和腋后线扫描后胸壁。对于每个半侧胸腔，计算积液指数，即沿扫描线PE上下限之间肋间间隙之和除以3。所有患者入院时及出院时均行标准胸部X线检查，并进行定性评分（0分，无积液；1分，少量积液；2分，大量PE）。使用kappa统计量和Kruskal-Wallis检验比较HCU设备和X线检查结果。
所有患者均可行胸部超声检查（平均[±标准差]时间，5±2分钟）。与胸部超声相比，体格检查的敏感性为69%，特异性为77%。入院时，HCU设备在140个半侧胸腔中的72个检测到PE。与X线检查结果的一致性为76%（kappa = 0.52）。在15个半侧胸腔中，HCU设备检测到X线检查未诊断出的PE。相反，在18个半侧胸腔中，X线检查诊断出的PE未得到HCU设备的证实。超声与X线评分之间的相关性具有统计学意义（p < 0.001）。出院时，根据HCU设备检查结果，140个半侧胸腔中有31个存在PE，根据X线检查结果，140个半侧胸腔中有38个存在PE（一致性，78%；kappa = 0.44）。
在心脏手术后早期患者中，HCU设备可快速检测PE并改善临床诊断。与X线检查相比，该方法具有无需辐射暴露即可在床边评估患者的独特优势。
