床边超声检查在急诊科用于检测小肠梗阻。

Bedside ultrasonography for the detection of small bowel obstruction in the emergency department.

机构信息

Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Olive View Medical Center and UCLA Medical Center, 1000 W. Carson Street, D-9A, Torrance, California 90509, USA.

出版信息

Emerg Med J. 2011 Aug;28(8):676-8. doi: 10.1136/emj.2010.095729. Epub 2010 Aug 22.

DOI:10.1136/emj.2010.095729

PMID:20732861

Abstract

BACKGROUND

Plain film radiography (x-ray) is often the initial study in patients with suspected small bowel obstruction (SBO) to expedite patient care.

OBJECTIVE

To compare bedside ultrasonography (US) and x-ray for the detection of SBO.

METHODS

This was a prospective study using a convenience sample of patients presenting to the emergency department (ED) with abdominal pain, vomiting, or other symptoms suggestive of a SBO. Patients were evaluated with US prior to x-ray and CT. US was performed by emergency physicians (EPs) who completed a 10 min training module and five prior US exams for SBO. The criterion standard for the diagnosis of SBO was the results of CT read by board-certified radiologists.

RESULTS

In all, 76 patients were enrolled and evaluated with US for SBO. A total of 33 (43%) were diagnosed as having SBO. Dilated bowel on US had a sensitivity of 91% (95% CI 75 to 98%) and specificity of 84% (95% CI 69 to 93%) for SBO, compared to 27% (95% CI 14 to 46%) and 98% (95% CI 86 to 100%) for decreased bowel peristalsis on US. X-ray had a sensitivity of 46.2% (95% CI 20.4 to 73.9%) and specificity of 66.7% (95% CI 48.9 to 80.9%) for SBO when diagnostic, but was non-diagnostic 36% of the time.

CONCLUSION

EP-performed US compares favourably to x-ray in the diagnosis of SBO.

摘要

背景

在疑似小肠梗阻（SBO）患者中，平片 X 线摄影通常是初始检查，以加快患者治疗速度。

目的

比较床边超声（US）和 X 线摄影在 SBO 检测中的应用。

方法

这是一项前瞻性研究，使用便利抽样法选取因腹痛、呕吐或其他疑似 SBO 症状就诊于急诊科的患者。患者在接受 X 线和 CT 检查前接受 US 检查。US 由接受过 10 分钟培训模块和 5 次 SBO 前 US 检查的急诊医师（EP）进行。SBO 的诊断标准是由经过董事会认证的放射科医师阅读 CT 的结果。

结果

共纳入 76 例患者进行 SBO 的 US 评估。共有 33 例（43%）被诊断为 SBO。US 上扩张的肠管对 SBO 的敏感性为 91%（95%CI 75%至 98%），特异性为 84%（95%CI 69%至 93%），而 US 上肠蠕动减少的敏感性为 27%（95%CI 14%至 46%），特异性为 98%（95%CI 86%至 100%）。当 X 线摄影具有诊断意义时，其对 SBO 的敏感性为 46.2%（95%CI 20.4%至 73.9%），特异性为 66.7%（95%CI 48.9%至 80.9%），但有 36%的时间为非诊断性。