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床旁超声对急诊科小肠梗阻诊断和管理的影响:一项回顾性观察性单中心研究

The Impact of Point-of-Care Ultrasound on the Diagnosis and Management of Small Bowel Obstruction in the Emergency Department: A Retrospective Observational Single-Center Study.

作者信息

Di Gioia Carmine Cristiano, Alame Alice, Orso Daniele

机构信息

Department of Emergency Medicine, Community Hospital of Baggiovara (MO), Azienda Ospedaliero-Universitaria di Modena, 41125 Modena, Italy.

Faculty of Medicine and Surgery, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy.

出版信息

Medicina (Kaunas). 2024 Dec 4;60(12):2006. doi: 10.3390/medicina60122006.

DOI:10.3390/medicina60122006
PMID:39768886
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11727861/
Abstract

: Small bowel obstruction (SBO) requires prompt diagnosis and management. Due to its advantages, POCUS can be beneficial when assessing SBO. However, it is still doubtful whether POCUS performed by an emergency doctor can prolong the time of patients with SBO in the emergency department (ED). The primary outcome was time to diagnosis when using POCUS compared to not using it. Secondary outcomes included the processing time in the ED, ED length of stay (LOS), rates of abdominal radiography, hospital LOS, and mortality. : We conducted a retrospective, observational study in our ED from 1 November 2021 to 31 December 2023, including patients aged 18 and older diagnosed with SBO. Both groups received confirmation of their diagnosis through contrast-enhanced computed tomography. The two groups of patients (POCUS group vs. non-POCUS group) were compared regarding the time needed to reach the final diagnosis (i.e., time to diagnosis), the ED LOS, the hospital LOS, and in-hospital mortality. : A total of 106 patients were included. The median time to diagnosis was 121 min for the POCUS group vs. 217 min for the non-POCUS group ( < 0.001). Median ED processing time was 276 min in the POCUS group compared to 376 min in the non-POCUS group ( = 0.006). ED LOS was also shorter in the POCUS group (333 vs. 436 min, = 0.010). Abdominal X-ray rates were lower in the POCUS group (49% vs. 78%, = 0.004). Hospital LOS was similar between the two groups ( = 1.000). Five non-POCUS patients died during hospitalization; none died in the POCUS group, but the difference was not statistically significant ( = 0.063). : POCUS significantly reduced time to diagnosis and ED LOS. Further exploration is needed to assess long-term outcomes and the cost-effectiveness of integrating POCUS into ED practice.

摘要

小肠梗阻(SBO)需要及时诊断和处理。由于其优势,床旁超声(POCUS)在评估SBO时可能有益。然而,急诊医生进行的POCUS是否能延长SBO患者在急诊科(ED)的停留时间仍存在疑问。主要结局是使用POCUS与不使用POCUS时的诊断时间。次要结局包括在ED的处理时间、ED住院时间(LOS)、腹部X线检查率、住院LOS和死亡率。

我们于2021年11月1日至2023年12月31日在我们的ED进行了一项回顾性观察研究,纳入年龄在18岁及以上诊断为SBO的患者。两组均通过对比增强计算机断层扫描确诊。比较两组患者(POCUS组与非POCUS组)达到最终诊断所需的时间(即诊断时间)、ED LOS、住院LOS和住院死亡率。

共纳入106例患者。POCUS组的中位诊断时间为121分钟,而非POCUS组为217分钟(<0.001)。POCUS组的中位ED处理时间为276分钟,而非POCUS组为376分钟(=0.006)。POCUS组的ED LOS也更短(333分钟对436分钟,=0.010)。POCUS组的腹部X线检查率更低(49%对78%,=0.004)。两组的住院LOS相似(=1.000)。5例非POCUS患者在住院期间死亡;POCUS组无死亡病例,但差异无统计学意义(=0.063)。

POCUS显著缩短了诊断时间和ED LOS。需要进一步探索以评估将POCUS纳入ED实践的长期结局和成本效益。

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本文引用的文献

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AGA Clinical Practice Update on the Role of Intestinal Ultrasound in Inflammatory Bowel Disease: Commentary.AGA 临床实践更新:肠超声在炎症性肠病中的作用:评论。
Clin Gastroenterol Hepatol. 2024 Sep;22(9):1790-1795.e1. doi: 10.1016/j.cgh.2024.04.039. Epub 2024 Jul 10.
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Best Practices for Point of Care Ultrasound: An Interdisciplinary Expert Consensus.床旁超声最佳实践:跨学科专家共识
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Impact of emergency physician performed ultrasound in the evaluation of adult patients with acute abdominal pain: a prospective randomized bicentric trial.
急诊医师施行超声检查对成人急性腹痛患者评估的影响:一项前瞻性随机双中心试验。
Scand J Trauma Resusc Emerg Med. 2024 Feb 26;32(1):15. doi: 10.1186/s13049-024-01182-5.
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Multi-center analysis of point-of-care ultrasound for small bowel obstruction: A systematic review and individual patient-level meta-analysis.基于多中心的即时超声检查在小肠梗阻中的应用:系统综述和个体患者水平的荟萃分析。
Am J Emerg Med. 2023 Aug;70:144-150. doi: 10.1016/j.ajem.2023.05.039. Epub 2023 Jun 1.
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Can point-of-care ultrasound speed up time to diagnosis for small bowel obstruction?即时超声检查能否加快小肠梗阻的诊断时间?
Acad Emerg Med. 2022 Nov;29(11):1379-1380. doi: 10.1111/acem.14570. Epub 2022 Aug 11.
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Point-of-Care Ultrasonography as an Extension of the Physical Examination for Abdominal Pain in the Emergency Department: The Diagnosis of Small-Bowel Volvulus as a Rare Complication after Changing the Feeding Jejunostomy Tube.床旁超声检查作为急诊科腹痛体格检查的延伸:空肠造口喂养管更换后罕见并发症小肠扭转的诊断
Diagnostics (Basel). 2022 May 6;12(5):1153. doi: 10.3390/diagnostics12051153.
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Overview of point-of-care ultrasound in diagnosing intestinal obstruction.床旁超声诊断肠梗阻概述
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Diagnosis and management of small bowel obstruction in virgin abdomen: a WSES position paper.原发性腹部小肠梗阻的诊断与治疗:WSES 立场文件。
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