Henry J W, Stein P D, Gottschalk A, Relyea B, Leeper K V
Henry Ford Heart and Vascular Institute, Detroit, MI 48202-2691, USA.
Chest. 1996 Feb;109(2):462-6. doi: 10.1378/chest.109.2.462.
The purpose of this investigation was to evaluate the diagnostic accuracy of radionuclide scintigraphic lung scans and clinical assessment in critically ill patients with suspected acute pulmonary embolism.
Critically ill patients were defined as follows: (1) patients who were hypoxemic on room air, and not given ventilatory support (n = 89); (2) patients given ventilatory support (n = 46); and (3) patients in ICUs, but not given ventilatory support (n = 85), and hypotensive patients who were not hypoxemic or given ventilatory support (n = 3). Comparisons were made with patients who had none of these characteristics of critically ill patients (n = 627). Data are from the Prospective Investigation of Pulmonary Embolism Diagnosis.
The sensitivities, specificities, and positive predictive values of high probability lungs scans among each of the four categories of critically ill patients were not statistically significantly lower than values in noncritically ill patients. The positive predictive values of the clinical assessments did not differ to a statistically significant extent from noncritically ill patients. Clinical assessment, when concordant with the lung scan interpretation, usually increased the positive predictive value for pulmonary embolism.
Scintigraphic lung scans and clinical assessment retain their diagnostic value even in critically ill patients.
本研究旨在评估放射性核素肺扫描及临床评估对疑似急性肺栓塞的危重症患者的诊断准确性。
危重症患者定义如下：（1）在室内空气中存在低氧血症且未接受通气支持的患者（n = 89）；（2）接受通气支持的患者（n = 46）；（3）入住重症监护病房但未接受通气支持的患者（n = 85），以及不存在低氧血症或未接受通气支持的低血压患者（n = 3）。将这些患者与不具备这些危重症患者特征的患者（n = 627）进行比较。数据来自肺栓塞诊断前瞻性研究。
四类危重症患者中，高概率肺扫描的敏感性、特异性和阳性预测值与非危重症患者相比，差异均无统计学意义。临床评估的阳性预测值与非危重症患者相比，差异也无统计学意义。当临床评估与肺扫描结果一致时，通常会提高肺栓塞的阳性预测值。
即使在危重症患者中，肺扫描及临床评估仍保留其诊断价值。
