[作者单位] 1.浙江大学医学院附属第二医院急诊科,浙江 杭州

    310009 ; 2.浙江大学医学院附属第二医院超声医学科; 3.杭州市

    萧山中医院 ICU

    [作者简介] 张茂(1974 - ) ,男,博士研究生,主治医师,从事急诊创

    伤与危重病的救治及研究。

    ICU医师应用超声诊断危重患者气胸的价值研究

    张 茂1

    , 杨俭新1

    , 干建新1

    , 游向东2

    , 刘志海1

    , 高海霞3

    , 江观玉1

    [摘 要] 目的 探讨 ICU医师应用床旁超声诊断危重患者气胸的可行性及临床价值。方法 2004 - 09～2005 - 07急

    诊 ICU收治101例危重患者 ,由 ICU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 3 h

    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 ICU医师完成的超声检查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了简单、快速而安全有效的手段。

    [关键词] 气胸; 超声检查; 危重患者

    [中图分类号] R 44511 [文献标识码] A [文章编号] 1002 - 1949(2006) 02 - 0111 - 04

    Study on the value of intensivist - performed ultrasonography to detect pneumothorax in critically ill patients ZHANG Mao , YANG

    Jian - xin , GAN Jian - xin , et al . Department of Emergency , the 2 nd Aff iliated Hospital , Medical College of Zhejiang University , Hangzhou

    310009 , China

    [ Abstract] Objective To discuss the feasibility and value of intensivist - performed ultrasonography to detect pneumothorax in critically

    ill patients. Methods It’ s a prospective , double - blinded and controlled study. From Sep 2004 to July 2005 , 101 critically ill patients admit 2

    ted to emergency ICU were enrolled and bedside thoracic ultrasonography were performed by intensivists. Pneumothorax was diagnosed when the

    two signs (lung - sliding and comet - tail) disappeared. Chest CT scan and bedside radiography were done within three hours. The result of CT

    was regarded as a golden standard , and the value of ultrasonography and radiography were compared. Results In 101 cases , pneumothorax ex 2

    isted in 21 hemithoraces of 19 patients by CT, in 18 hemithoraces of 17 patients by ultrasonography , but only 4 hemithoraces in 4 patients was

    found by radiography. The corresponding data of sensitivity , specificity , positive predictive value , negative predictive value and accuracy by ul 2

    trasonography 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 the results between ultrasonography and CTwas higher than that

    between radiography and CT. Conclusions Intensivist - performed ultrasonography has higher sensitivity and specificity in detecting pneumotho 2

    rax , which supply easy , rapid ,safe and effective detection of pneumothorax in critically ill patients.

    [ Key words] Pneumothorax ; Ultrasonography ; Critically ill patients

    近年来 ,国外开始应用超声诊断气胸[1～3 ]

    ,提示

    对危重患者有较好的应用前景 ,但作者尚未见国内

    相关的应用报道。我们从 2004 - 09 开始 ,由 ICU 医

    师应用超声对本院急诊 ICU( EICU)收治的 101 例危

    重患者进行检查 ,并以床旁 X片和 CT为对照 ,探讨

    其对危重患者气胸诊断的可行性与价值。

    1 资料与方法

    1. 1 资料 2004 - 09～2005 - 07本院 EICU收治的危

    重患者,排除未能完成 CT检查者,共计 101 例,其中

    男86例,女15例;年龄9～78岁,平均46± 15岁。基

    础疾病构成:以多发性创伤为主,共97例,其中57例

    有明确的胸部外伤;严重肺部感染 2 例;脑血管意外

    和急性CO中毒各1例。61例患者进行机械通气。

    1. 2 方法 采用前瞻、双盲对照研究。超声检查由

    接受过专门胸部超声技能培训的 ICU 医师完成 ,通

    常在下列情况下进行: ①合并胸部创伤或机械通气

    患者初入 EICU ; ②作为 EICU 患者日常胸部评估的

    内容; ③患者发生呼吸功能突然恶化; ④临床医师怀

    疑患者胸部有异常; ⑤患者因临床需要行胸部 CT

    检查 ......