Hornick P I, Harris P, Cousins C, Taylor K M, Keogh B E
Department of Cardiothoracic Surgery, Hammersmith Hospital, London, England.
Ann Thorac Surg. 1995 May;59(5):1150-3; discussion 1153-4. doi: 10.1016/0003-4975(95)00087-2.
The value of the immediate postoperative chest radiograph upon a patient's return to the intensive care unit after a cardiac surgical procedure is uncertain. This study represents a prospective analysis of the immediate postoperative radiograph in 100 consecutive adult patients undergoing cardiac operations. In 11 patients it was found that the routine postoperative radiograph was of value when it was necessary either to clarify or confirm clinical findings or to check the position of an intraaortic balloon catheter. For those chest radiographs that were deemed unnecessary, only one of 89 were found to be of clinical value. Furthermore, in those situations in which an emergency radiograph was obtained, the routine radiograph was not found to be contributory to patient management. We conclude that the policy of obtaining routine, immediate postoperative chest radiographs in the absence of a specific clinical indication provides virtually no additional clinical yield. Residents should therefore request radiographs only to check the position of an intraaortic balloon catheter, and to clarify or confirm a clinical diagnosis.
心脏外科手术后患者返回重症监护病房时即刻拍摄的胸部X光片的价值尚不确定。本研究对100例连续接受心脏手术的成年患者术后即刻X光片进行了前瞻性分析。在11例患者中，发现当需要明确或确认临床发现或检查主动脉内球囊导管位置时，术后常规X光片具有价值。对于那些被认为不必要的胸部X光片，89例中只有1例被发现具有临床价值。此外，在那些进行急诊X光检查的情况下，未发现常规X光片对患者管理有帮助。我们得出结论，在没有特定临床指征的情况下获取术后即刻常规胸部X光片的策略几乎不会带来额外的临床收益。因此，住院医生仅应在检查主动脉内球囊导管位置以及明确或确认临床诊断时才要求拍摄X光片。
