[北京协和医院重症超声管理方案对ICU患者呼吸困难和/或血流动力学不稳定病因诊断的影响]

[The effects of Peking Union Medical College Hospital Critical Ultrasonic Management scheme on the etiological diagnosis of dyspnea and/or hemodynamic instability in ICU patients].

作者信息

Wang Xiaoting, Zhao Hua, Liu Dawei, Zhang Hongmin, Du Wei, Chai Wenzhao, Zhang Qing, Chao Yangong, Yin Wanhong, Zhang Lina, Wang Chunxian

机构信息

Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences,Beijing 100730, China. Email:

出版信息

Zhonghua Nei Ke Za Zhi. 2014 Oct;53(10):793-8.

PMID:25567151

Abstract

OBJECTIVE

To investigate the effects of Peking Union Medical College Hospital (PUMCH) Critical Ultrasonic Management (PCUM) scheme on the etiological diagnosis and treatment decisions for the patients with dyspnea and/or hemodynamic instability in ICU.

METHODS

Patients who suffered from dyspnea and/or hemodynamic instability in PUMCH ICU were included in this study. The time to preliminary diagnosis, time to final diagnosis, diagnostic accuracy, time to accurate treatment, time to consultation with other specialties, time to other examinations were recorded.

RESULTS

A total of 129 patients were included in this study. In patients applied with PCUM scheme, time to preliminary diagnosis, final diagnosis and accurate treatment were (15 ± 6)min, (65 ± 16)min and (34 ± 14)min respectively, and the accuracy of diagnosis was 93.0%. PCUM patients had high sensitivity and specificity for the diagnosis of acute respiratory distress syndrome (ARDS)(sensitivity 90.2%/specificity 93.6%), distributive shock(sensitivity 92.5%/specificity 93.6%) and pulmonary edema(sensitivity 93.4%/specificity 92.7%) etc.

CONCLUSIONS

The PCUM scheme is associated with short time to preliminary diagnosis and high diagnostic accuracy and could improve the treatment for patients with dyspnea and/or hemodynamic instability.

摘要

目的

探讨北京协和医院重症超声管理（PCUM）方案对重症监护病房（ICU）中出现呼吸困难和/或血流动力学不稳定患者的病因诊断及治疗决策的影响。

方法

纳入北京协和医院ICU中出现呼吸困难和/或血流动力学不稳定的患者。记录初步诊断时间、最终诊断时间、诊断准确率、准确治疗时间、与其他专科会诊时间、其他检查时间。

结果

本研究共纳入129例患者。应用PCUM方案的患者，初步诊断时间、最终诊断时间和准确治疗时间分别为（15±6）分钟、（65±16）分钟和（34±14）分钟，诊断准确率为93.0%。PCUM方案对急性呼吸窘迫综合征（ARDS）（敏感性90.2%/特异性93.6%）、分布性休克（敏感性92.5%/特异性93.6%）和肺水肿（敏感性93.4%/特异性92.7%）等疾病的诊断具有较高的敏感性和特异性。