【作者】 张茂； 杨俭新； 干建新； 游向东； 刘志海； 高海霞； 江观玉；

【Author】 ZHANG Mao, YANG Jian-xin, GAN Jian-xin, et al. Department of emergency, 2nd affiliated hospital, school of medicine, Zhejiang university, Hangzhou 310009, China

【机构】 浙江大学医学院附属第二医院急诊科； 浙江大学医学院附属第二医院超声医学科； 杭州市萧山中医院ICU；

【摘要】 目的:探讨床旁超声诊断危重患者气胸的可行性及临床价值。方法:前瞻性、双盲对照研究。 2004．09～2005．05本院急诊ICU收治的101例危重患者,由一名固定的临床医师进行床旁胸部超声检查,以“肺滑行”和“彗尾”征消失诊断气胸。在超声检查前后3h内行胸部CT和床旁X片检查,以CT结果为“金标准”比较超声和X片诊断气胸的价值。结果:101例危重患者中CT确诊气胸19例21侧,超声诊断17例18侧,X片诊断4 例4侧,相应的诊断敏感性、特异性、阳性预测值、阴性预测值和准确度分别为85．7％对19．0％(P<0．001)、98．9 ％对100％(P=0．499)、90．0％对100％(P=1．0)、98．4％对91．4％(P=0．002)和97．5％对91．6％(P=0．009)。超声与CT诊断气胸的一致性高于X片。结论:床旁超声诊断气胸具有较高的敏感性和特异性,为危重患者气胸的诊断提供一种便捷、安全而有效的手段,值得推广应用。更多还原

【Abstract】 Objective: To evaluate the feasibility and application of bedside ultrasonography in detecting pneumothorax in critical ill patients. Methods: Prospective, double-blind control study. From Sep 2004 to May 2005, 101 critical ill patients admitted to emergency ICU were enrolled and bedside thoracic ultrasonography were performed by a certain physician. Pneumothorax was considered when the two normal signs (lung-sliding and comet-tail) disappeared. Chest CT scan and bedside radiography were taken within three hours. The result of CT was regarded as a golden standard, and those of ultrasonography and radiography were compared. Results: 21 hemithoraces in 19 patients of 101 cases had pneumothoraces at CT. Ultrasonography demonstrated the presence of pneumothorax in 18 hemithoraces in 17 patients, but only 4 hemithoraces in 4 patients was found by radiography. The corresponding data on performance (sensitivity, specificity, false-positive rate, false-negative rate and accuracy) of ultrasonography and radiography were 85.7% vs 19.0% (P<0.001),98.9% vs 100%(P=0.499), 90.0% vs 100%(P= 1.0), 98.4% vs 91.4%(P= 0.002) and 97.5% vs 91.6%(P= 0.009). Consistency of results between ultrasonography and CT was higher than that between radiography and CT. Conclusions: Bedside ultrasonography has higher sensitivity and specificity in detecting pneumothorax. It may serve as a convenient, safe and effective alternative for detection of pneumothorax in critical ill patients, and deserves broad application.更多还原