CAJ | 학술논문

目的探索危重患者胸腔积液超声精确测量的新方法 .方法选择收住急诊ICU的危重患者46例,应用超声在平卧位、呼气末测定胸腔积液的高度(H)、中间层积液的面积(S)和在后背正中线、腋后线处的厚度(T1、T2),以H×S估算胸腔积液量(Vc),胸腔置管充分引流获取实际积液量.分析胸腔积液实际量与积液高度、厚度、面积及估算量的相关性,比较不同指标和方法估算积液量的准确性.结果在总组和各亚组中,胸腔积液实际量与S、(H和S)、Vc的相关性明显好于T1、T2和H.超声测量新方法获取的估算量与实际积液量有较好的相关性(r=0.778,P＜0.001),而且非常接近实际积液量(平均相差56 ml),尤其在积液量＜500 ml时两者的差别无统计学意义[(417±94)ml对(402±95)ml,t=1.095,P=0.285].Logistic逐步回归分析和受试者工作特征曲线(ROC)分析均表明,以H、S、T1、T2预测实际积液量＞500 ml、400 ml和300 ml,其中以S最为可靠,其阈值分别为30.3 cm2、28.3 cm2和23.1cm2,相应的敏感性和特异性分别为0.77和0.88,0.72和1.0,0.95和1.0.结论基于积液面积测定基础上建立的胸腔积液超声新测量方法较传统方法更可靠和精确,具有重要的临床价值,且测定技术简单,值得推广应用.
목적 탐색위중환자흉강적액초성정학측량적신방법 .방법 선택수주급진ICU적위중환자46례,응용초성재평와위、호기말측정흉강적액적고도(H)、중간층적액적면적(S)화재후배정중선、액후선처적후도(T1、T2),이H×S고산흉강적액량(Vc),흉강치관충분인류획취실제적액량.분석흉강적액실제량여적액고도、후도、면적급고산량적상관성,비교불동지표화방법 고산적액량적준학성.결과 재총조화각아조중,흉강적액실제량여S、(H화S)、Vc적상관성명현호우T1、T2화H.초성측량신방법 획취적고산량여실제적액량유교호적상관성(r=0.778,P＜0.001),이차비상접근실제적액량(평균상차56 ml),우기재적액량＜500 ml시량자적차별무통계학의의[(417±94)ml대(402±95)ml,t=1.095,P=0.285].Logistic축보회귀분석화수시자공작특정곡선(ROC)분석균표명,이H、S、T1、T2예측실제적액량＞500 ml、400 ml화300 ml,기중이S최위가고,기역치분별위30.3 cm2、28.3 cm2화23.1cm2,상응적민감성화특이성분별위0.77화0.88,0.72화1.0,0.95화1.0.결론 기우적액면적측정기출상건립적흉강적액초성신측량방법 교전통방법 경가고화정학,구유중요적림상개치,차측정기술간단,치득추엄응용.
Objective To develop a new method to measure pleural effusion volume by ultrasound in critically ill patients. Methods Forty-six critically ill patients admitted to emergency ICU were involved.The height of effusion (H),area of effusion at the middle section (S), thickness of effusion at middle-back line (T1) and posterior axillary line (T2) were measured by ultrasound in supine position at the end of expiration. The measured volume of pleural effusion (Vc) was calculated by H×S,and the actual volume of drainage (V) within 2 hours was also recorded. The correlation of actual volume of pleural effusion (V)with effusion height (H) ,thickness (T1, T2), area (S) and the calculated volume (Vc) were analyzed to decide the most accurate index and method. Results There was much better correlation between actual volume of effusion and S, (H & S), Vc, than these between V and T1 ,T2, H in all patients and subgroup, Vc had good correlation with V and very close to V(the average difference was 56 ml) when the actual volume was less than 500 ml,there was no difference[(417 ± 94)ml vs (402±95)ml, t = 1.095, P = 0. 285]. Both Logistic regression analysis and receiver operating characteristic (ROC) curve showed S was the most reliable index to predict the actual volume to exceed 500 ml,400 ml,and 300 ml when compared with H,S,T1 and T2. The corresponding threshold was 30.3 cm2 , 28.3 cm2 and 23. 1 cm2 , with the sensitivity and specificity of 0. 77 and 0. 88,0.72 and 1.0,0.95 and 1.0, respectively. Conclusions This new method based on measuring the area of effusion by ultrasound is more efficient and reliable than those traditional ones to measure the volume of pleural effusion. It's clinically valuable and easy to perform, and deserves broad application.