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麻醉医师术中即时超声 (POCUS):概述。

Perioperative Point of Care Ultrasound (POCUS) for Anesthesiologists: an Overview.

机构信息

Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.

Department of Anesthesiology and Pharmacology, Toxicology, and Neurosciences; Vice Chancellor of Academic Affairs, Chief Academic Officer, and Provost, Louisiana State University School of Medicine, Shreveport, LA, USA.

出版信息

Curr Pain Headache Rep. 2020 Mar 21;24(5):20. doi: 10.1007/s11916-020-0847-0.

Abstract

PURPOSE OF REVIEW

Point of care ultrasound (POCUS) has played a role across almost every medical specialty. Although anesthesiologists have been using bedside ultrasound for nerve blocks and vascular access for many years now, there has been a recent push to incorporate whole-body POCUS into anesthesiologists' training and daily practice. This article provides a brief overview of the indications, techniques for image acquisition, and general principles in interpreting basic images.

RECENT FINDINGS

Whole-body POCUS can provide quick diagnoses and impact clinical management across relevant pre-, intra-, and post-operative settings. Anesthesia providers need to understand different applications for POCUS, including focused cardiac ultrasound (FoCUS), lung ultrasound (LUS), gastric ultrasound, abdominopelvic ultrasound, and the use of ultrasound for airway management. Currently, there is no standard ultrasound curriculum for anesthesiology residents, and teaching methods include informal bedside teaching, structured expert demonstration, didactic lectures, and simulations. Model/simulation-based lecture series may be effective in teaching ultrasound to anesthesiology residents, and e-learning and traditional didactics are both equally effective in teaching POCUS applications such as LUS and focused assessment with sonography in trauma (FAST). Creating protocol-guided frameworks for POCUS, such as I-AIM (indication, acquisition, interpretation, medical decision making), can also ensure more consistent and reliable diagnoses and interpretations of findings. Applications of POCUS should be focused, goal-oriented, easily learned, rapidly performable at bedside, accurate, and reliable. A variety of studies have shown this potential for POCUS in assessing cardiac, pulmonary, and intraabdominal pathologies, making it an emerging area of interest in medicine. The incorporation of POCUS into perioperative medicine provides an important tool to ensure continued improvement in coordinating care for patients in the perioperative period.

摘要

目的综述

床边即时超声(POCUS)已在几乎所有医学专业中得到应用。尽管麻醉医师多年来一直在使用床边超声进行神经阻滞和血管通路,但最近已推动将全身 POCUS 纳入麻醉医师的培训和日常实践中。本文简要概述了适应证、图像采集技术以及解读基本图像的一般原则。

最新发现

全身 POCUS 可在相关术前、术中和术后环境中提供快速诊断并影响临床管理。麻醉医师需要了解 POCUS 的不同应用,包括心脏超声聚焦(FoCUS)、肺部超声(LUS)、胃超声、腹盆腔超声以及用于气道管理的超声。目前,麻醉住院医师没有标准的超声课程,教学方法包括非正式的床边教学、结构化专家演示、讲座和模拟。基于模型/模拟的讲座系列可能在教授麻醉住院医师超声方面有效,电子学习和传统教学在教授 LUS 和创伤超声重点评估(FAST)等 POCUS 应用方面同样有效。为 POCUS 创建基于方案的框架,例如 I-AIM(适应证、采集、解读、医学决策),也可以确保更一致和可靠的诊断和解读。POCUS 的应用应具有针对性、目标明确、易于学习、可在床边快速进行、准确且可靠。多项研究表明,POCUS 在评估心脏、肺部和腹腔内病理方面具有这种潜力,使其成为医学中一个新兴的研究领域。将 POCUS 纳入围手术期医学为确保在围手术期期间持续改善患者的护理协调提供了重要工具。

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