Wastl Daniel, Löwe Axel, Dietrich Christoph F
Medizinische Klinik, Krankenhaus Nordwest Frankfurt am Main, Steinbacher Hohl 2-26, 60488, Frankfurt am Main, Germany.
Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permancence, Bern, Switzerland.
Med Klin Intensivmed Notfmed. 2023 Apr;118(3):228-235. doi: 10.1007/s00063-022-00926-4. Epub 2022 Jun 2.
Targeted ultrasound examinations with portable ultrasound device (handheld ultrasound system [HHUS]) have been defined as "echoscopy" by the European Federation of Societies of Ultrasound in Medicine and Biology (EFSUMB). For abdominal diseases it has been shown that echoscopy is sensitive and specific. The aim of this study is to show that the use of HHUS for abdominal ultrasonography is possible under the conditions prevailing in emergency and intensive care medicine and that it is not inferior to high-end devices (high-end ultrasound systems [HEUS]).
Examinations were carried out with a first-generation Vscan™ (GE Medical Systems, Solingen, Germany) and HEUS device (Siemens Acuson X‑300 or X‑700, Siemens Healthcare, Erlangen, Germany). The HEUS device was seen as standard. The examinations were randomized and blinded and carried out by two examiners within 30 min in order to avoid falsifications due to time delay. They took place in the intensive care unit, the emergency room and the emergency medical service. The results had to be recorded in an examination sheet.
In all, 86 patients (54 men and 32 women, aged 73 ± 14.58 [28-95] years) were included. In 45.35% (39/86) of the ultrasound examinations using HEUS and in 41.86% (36/89) of the cases using HHUS the examination conditions were optimal. Furthermore, 76.19% of the examinations were carried out by both examiners in the same scanning position. For the detection of liver tumours, HHUS shows a sensitivity of 70% and specificity of 100%. With regard to identifying signs of cholecystitis, i.e., evidence of surrounding inflammation (a) or hydrops (b), HHUS shows a sensitivity of 66.67% (a) and 60% (b) and a specificity of 97.06% (a) and 96.86% (b). The diagnosis of an ileus is successful with a sensitivity of 87.5% and a specificity of 60%. The respiratory variability of the inferior vena cava has a sensitivity of 100% and a specificity of 40% using HHUS. Ascites and pleural effusions can be diagnosed with a sensitivity of 89% and a specificity of 93.1%. When using the FAST (Focused Assessment with Sonography for Trauma) protocol, HHUS has a sensitivity of 80% and a specificity of 90.9%. With the exception of kidney cysts and inferior vena cava, the measurement of the diameter has a positive correlation.
Echoscopy of the abdomen in emergency and intensive care medicine is possible despite restrictive circumstances. The inferior vena cava can only be assessed to a limited extent with the first generation of Vscan™. In order to use sonography in emergency and intensive care medicine, a standardized procedure is to be aimed for and training in emergency sonography is necessary.
欧洲医学与生物学超声学会联合会（EFSUMB）将使用便携式超声设备（手持式超声系统[HHUS]）进行的靶向超声检查定义为“超声检查”。对于腹部疾病，已证明超声检查具有敏感性和特异性。本研究的目的是表明，在急诊和重症医学的现有条件下，使用HHUS进行腹部超声检查是可行的，且其并不逊色于高端设备（高端超声系统[HEUS]）。
使用第一代Vscan™（通用电气医疗系统公司，德国索林根）和HEUS设备（西门子Acuson X-300或X-700，西门子医疗公司，德国埃尔朗根）进行检查。将HEUS设备视为标准。检查采用随机、盲法，由两名检查人员在30分钟内完成，以避免因时间延迟导致的结果偏差。检查在重症监护病房、急诊室和紧急医疗服务中进行。结果必须记录在检查表中。
共纳入86例患者（54例男性和32例女性，年龄73±14.58[28-95]岁）。在使用HEUS进行的超声检查中，45.35%（39/86）的检查条件最佳；在使用HHUS的病例中，41.86%（36/89）的检查条件最佳。此外，76.19%的检查由两名检查人员在相同扫描位置进行。对于肝肿瘤的检测，HHUS的敏感性为70%，特异性为100%。关于识别胆囊炎的征象，即周围炎症（a）或积液（b）的证据，HHUS的敏感性分别为66.67%（a）和60%（b），特异性分别为97.06%（a）和96.86%（b）。肠梗阻的诊断成功率为敏感性87.5%，特异性60%。使用HHUS时，下腔静脉的呼吸变异性敏感性为l00%，特异性为40%。腹水和胸腔积液的诊断敏感性为89%，特异性为93.1%。使用FAST（创伤超声重点评估）方案时，HHUS的敏感性为80%，特异性为90.9%。除肾囊肿和下腔静脉外，直径测量呈正相关。
尽管存在限制条件，但在急诊和重症医学中进行腹部超声检查是可行的。第一代Vscan™对下腔静脉的评估有限。为了在急诊和重症医学中使用超声检查，应制定标准化程序，且有必要进行急诊超声培训。
