由认证超声医师进行的床边腹部超声检查在钝性腹部创伤急诊评估中的临床价值。
Clinical value of bedside abdominal sonography performed by certified sonographer in emergency evaluation of blunt abdominal trauma.
作者信息
He Nie-Xia, Yu Jin-Hui, Zhao Wan-Yi, Gu Chun-Fang, Yin Ya-Fei, Pan Xu, Zhong Hua
机构信息
Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, China.
Department of Neurosurgery, Chongqing Yubei District People's Hospital, Chongqing, China.
出版信息
Chin J Traumatol. 2020 Oct;23(5):280-283. doi: 10.1016/j.cjtee.2020.07.001. Epub 2020 Jul 7.
PURPOSE
To investigate the accuracy and efficiency of bedside ultrasonography application performed by certified sonographer in emergency patients with blunt abdominal trauma.
METHODS
The study was carried out from 2017 to 2019. Findings in operations or on computed tomography (CT) were used as references to evaluate the accuracy of bedside abdominal ultrasonography. The time needed for bedside abdominal ultrasonography or CT examination was collected separately to evaluate the efficiency of bedside abdominal ultrasonography application.
RESULTS
Bedside abdominal ultrasonography was performed in 106 patients with blunt abdominal trauma, of which 71 critical patients received surgery. The overall diagnostic accordance rate was 88.68%. The diagnostic accordance rate for liver injury, spleen injury, kidney injury, gut perforation, retroperitoneal hematoma and multiple abdominal organ injury were 100%, 94.73%, 94.12%, 20.00%, 100% and 81.48%, respectively. Among the 71 critical patients, the diagnostic accordance rate was 94.37%, in which the diagnostic accordance rate for liver injury, spleen injury, kidney injury, gut perforation and multiple abdominal organ injury were 100%, 100%, 100%, 20.00% and 100%. The mean time for imaging examination of bedside abdominal ultrasonography was longer than that for CT scan (4.45 ± 1.63 vs. 2.38 ± 1.19) min; however, the mean waiting time before examination (7.37 ± 2.01 vs. 16.42 ± 6.37) min, the time to make a diagnostic report (6.42 ± 3.35 vs. 36.26 ± 13.33) min, and the overall time (17.24 ± 2.33 vs. 55.06 ± 6.96) min were shorter for bedside abdominal ultrasonography than for CT scan.
CONCLUSION
Bedside ultrasonography application provides both efficiency and reliability for the assessment of blunt abdominal trauma. Especially for patients with free peritoneal effusion and critical patients, bedside ultrasonography has been proved obvious advantageous. However, for negative bedside ultrasonography patients with blunt abdominal trauma, we recommend further abdominal CT scan or serial ultrasonography scans subsequently.
目的
探讨由资质认证超声医师对腹部钝性创伤急诊患者进行床旁超声检查的准确性和效率。
方法
研究于2017年至2019年开展。将手术或计算机断层扫描（CT）检查结果作为评估床旁腹部超声检查准确性的参照标准。分别收集床旁腹部超声检查或CT检查所需时间，以评估床旁腹部超声检查应用的效率。
结果
对106例腹部钝性创伤患者进行了床旁腹部超声检查，其中71例危重症患者接受了手术。总体诊断符合率为88.68%。肝损伤、脾损伤、肾损伤、肠穿孔、腹膜后血肿及多脏器损伤的诊断符合率分别为100%、94.73%、94.12%、20.00%、100%和81.48%。在71例危重症患者中，诊断符合率为94.37%，其中肝损伤、脾损伤、肾损伤、肠穿孔及多脏器损伤的诊断符合率分别为100%、100%、100%、20.00%和100%。床旁腹部超声检查的平均成像检查时间长于CT扫描（4.45±1.63对2.38±1.19）分钟；然而，床旁腹部超声检查的平均检查前等待时间（7.37±2.01对16.42±6.37）分钟、出具诊断报告时间（6.42±3.35对36.26±13.33）分钟及总用时（17.24±2.33对55.06±6.96）分钟均短于CT扫描。
结论
床旁超声检查应用为腹部钝性创伤评估提供了效率和可靠性。尤其对于有腹腔游离积液的患者及危重症患者，床旁超声检查已被证明具有明显优势。然而，对于腹部钝性创伤床旁超声检查阴性的患者，我们建议随后进一步行腹部CT扫描或系列超声检查。
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