CAJ | 학술논문

目的探讨超声对机械通气多发伤患者肺不张/实变的诊断价值和意义.方法对本院急诊ICU内接受机械通气治疗的81例多发伤患者进行胸部CT和超声检查,以CT结果为"金标准"评价超声诊断肺不张/实变的价值.并应用超声动态监测各种治疗措施对肺不张/实变的复张效果.结果 81例患者的324个肺区中,胸部CT确诊有154区肺不张/实变,其中大块型91区,部分型63区.超声诊断126区肺不张/实变,依其超声图像呼吸周期中的变化又分为完全性(87区)和不全性(39区),超声诊断的敏感性、特异性、阳性预测值、阴性预测值以及准确性分别为81.8%、100%、100%、85.9%和91.4%.超声与CT诊断肺不张/实变的一致性非常高(Kappa系数为0.825,P=0.031).进行各种肺复张措施后的3 d内,应用超声进行动态监测可发现有39区不全性肺不张/实变基本获得复张,87区完全性肺不张/实变中62区获得明显复张,总有效率达80.2%.结论床旁超声诊断机械通气多发伤患者的肺不张/实变方便、安全、直观、准确,能够动态监测并指导肺复张操作,可作为一种新的有效手段而值得推广应用.
목적 탐토초성대궤계통기다발상환자폐불장/실변적진단개치화의의.방법 대본원급진ICU내접수궤계통기치료적81례다발상환자진행흉부CT화초성검사,이CT결과위"금표준"평개초성진단폐불장/실변적개치.병응용초성동태감측각충치료조시대폐불장/실변적복장효과.결과 81례환자적324개폐구중,흉부CT학진유154구폐불장/실변,기중대괴형91구,부분형63구.초성진단126구폐불장/실변,의기초성도상호흡주기중적변화우분위완전성(87구)화불전성(39구),초성진단적민감성、특이성、양성예측치、음성예측치이급준학성분별위81.8%、100%、100%、85.9%화91.4%.초성여CT진단폐불장/실변적일치성비상고(Kappa계수위0.825,P=0.031).진행각충폐복장조시후적3 d내,응용초성진행동태감측가발현유39구불전성폐불장/실변기본획득복장,87구완전성폐불장/실변중62구획득명현복장,총유효솔체80.2%.결론 상방초성진단궤계통기다발상환자적폐불장/실변방편、안전、직관、준학,능구동태감측병지도폐복장조작,가작위일충신적유효수단이치득추엄응용.
Objective To evaluate the value and significance of bedside ultrasound in diagnosis of lung atelectasis/consolidation in multiple trauma patients with mechanical ventilation.Methods Bedside thoracic ultrasound and chest computed tomography(CT)were performed in 81 multiple trauma patients with mechanical ventilation admitted to the emergency intensive care unit(EICU).CT result was regarded as the "golden standard" to evaluate the value of ultrasound in diagnose lung atelectasis/consolidation.At the same time,the ultrasound was used to dynamically monitor the lung recruitment effect of the therapeutic measures.Results CT detected 154 regions of lung atelectasis/consolidation of 324 lung regions in 81 patients,while ultrasound detected 126 regions that were divided into 87 complete regions and 39 incomplete regions according to different sonogram in the breathing cycle.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of ultrasound were 81.8%,100%,100%,85.9% and 91.4% respectively.A concordance test showed a very high concordance between ultrasound and CT,with a Kappa coefficient of 0.825(P=0.031).Ultrasound found that 39 regions with incomplete lung atelectasis/consolidation were completely recruited and 62 out of 87 regions with complete lung atelectnsis/eonsolidatian gained visible recruitment within three days after different therapeutic measures,with total effective rate of 80.2%.Conclusion Bedside ultrasound can continuously monitor and guide the therapeutic measure to recruit the lung and is a convenient,safe,direct-viewing and accurate method for diagnosis of lung atelectasis/cansolidation in multiple trauma patients with mechanical ventilation.