真的越大越好吗？超便携掌上超声与即时床旁超声在胸腔穿刺术前安全进针部位评估和图像质量方面的比较。

Is Bigger Really Better? Comparison of Ultraportable Handheld Ultrasound with Standard Point-of-Care Ultrasound for Evaluating Safe Site Identification and Image Quality prior to Pleurocentesis.

机构信息

Respiratory and Sleep Services, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia,

College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia,

出版信息

Respiration. 2020;99(4):325-332. doi: 10.1159/000505698. Epub 2020 Mar 24.

DOI:10.1159/000505698

PMID:32208396

Abstract

BACKGROUND

Pleural effusions remain a common medical problem which often requires diagnostic pleurocentesis to determine the underlying cause. Pleurocentesis is a frequently performed procedure worldwide with improved safety using ultrasound (US) technology.

OBJECTIVES

This prospective, single-center study evaluated the use of an ultraportable handheld (UPHH) US compared with standard point-of-care (SPOC) US in determining a safe site for pleurocentesis. In addition, US image quality and factors impacting on image quality were assessed using both UPHH and SPOC US.

METHODS

Paired US assessments were performed by thoracic physicians using UPHH and SPOC US on patients with unilateral pleural effusions to determine a safe site for pleurocentesis (defined as >2 cm of pleural fluid, >2 cm from a solid organ/diaphragm, and <7 cm chest wall depth). Distance measurements for key structures and image quality scores (using a 5-point Likert rating scale) were obtained at the time of US assessment. Factors affecting image quality were analyzed using univariate analysis.

RESULTS

In 52 of the 54 included patients (96.3%), UPHH US was able to identify a safe site for pleurocentesis. Distance measurements between UPHH and SPOC US were not statistically different (all <0.5 cm with values of p > 0.05), but image quality was reduced in UPHH compared with SPOC US by 1 point on a 5-point Likert rating scale (p < 0.002). Increasing body mass index was associated with a reduction in image quality in both UPHH and SPOC US (all p < 0.01).

CONCLUSIONS

Although image quality was lower in UPHH than SPOC US, a safe site was found in 96.3% of patients, which suggests that UPHH US may be a useful tool for diagnostic pleuro-centesis when SPOC US is not available (http://www.anzctr.org.au/, Australia New Zealand Clinical Trials Registry, No. ACTRN12618001592235).

摘要

背景

胸腔积液仍然是一个常见的医学问题，通常需要诊断性胸腔穿刺术来确定潜在病因。胸腔穿刺术是一种在全球范围内广泛进行的程序，使用超声（US）技术可提高安全性。

目的

这项前瞻性、单中心研究评估了使用超便携手持（UPHH）US 与标准即时护理（SPOC）US 相比，在确定胸腔穿刺术安全部位方面的应用。此外，还使用 UPHH 和 SPOC US 评估了 US 图像质量和影响图像质量的因素。

方法

胸科医生对单侧胸腔积液患者同时进行 UPHH 和 SPOC US 评估，以确定胸腔穿刺术的安全部位（定义为>2 cm 的胸腔积液、>2 cm 远离实体器官/膈肌、<7 cm 胸壁深度）。在 US 评估时获得关键结构的距离测量值和图像质量评分（使用 5 分 Likert 评分量表）。使用单因素分析分析影响图像质量的因素。

结果

在 54 例纳入患者中的 52 例（96.3%）中，UPHH US 能够确定胸腔穿刺术的安全部位。UPHH 和 SPOC US 之间的距离测量值没有统计学差异（所有距离均<0.5 cm，p 值均>0.05），但 UPHH 的图像质量比 SPOC US 降低了 1 分（5 分 Likert 评分量表，p<0.002）。体重指数增加与 UPHH 和 SPOC US 图像质量下降相关（均 p<0.01）。

结论

尽管 UPHH 的图像质量低于 SPOC US，但在 96.3%的患者中找到了安全部位，这表明在无法获得 SPOC US 时，UPHH US 可能是诊断性胸腔穿刺术的有用工具（http://www.anzctr.org.au/，澳大利亚新西兰临床试验注册中心，注册号 ACTRN12618001592235）。