CAJ | 학술논문

目的评估由重症医学医师在重症监护病房(ICU)应用床旁彩色超声心动图对危重患者进行目标导向超声心动图(TTE)检查的可行性及其对临床决策的影响.方法重症医学医师经过12 h的TTE培训,对88例经过初步心脏临床评价的ICU患者进行TTE检查(2～4个二维视窗,未使用多普勒和M型超声),评价患者的左室功能、容量状态、有无局部心室壁运动异常及心包积液；由心脏超声医师重复检查以评价TTE质量及重症医学医师解释的准确性.结果重症医学医师成功完成了86例患者(97.7％)的TTE检查,正确解释了75例患者(85.2％)的超声心动图结果；TTE检查结果直接影响了22.7％患者的治疗(包括液体治疗、正性肌力药物及血管活性药物),45.5％患者获得有价值的信息,31.8％患者没有得到有用的信息；重症医学医师获得图像和解释的平均时间为(11.2±5.2) min.结论经过短暂的正规训练,重症医学医师可以可靠地完成ICU危重症患者的TTE检查,能够为相当数量的患者提供新的信息并改变其治疗.这项研究支持在国内重症医学医师培训课程中加入床旁TTE检查培训.
목적 평고유중증의학의사재중증감호병방(ICU)응용상방채색초성심동도대위중환자진행목표도향초성심동도(TTE)검사적가행성급기대림상결책적영향.방법 중증의학의사경과12 h적TTE배훈,대88례경과초보심장림상평개적ICU환자진행TTE검사(2～4개이유시창,미사용다보륵화M형초성),평개환자적좌실공능、용량상태、유무국부심실벽운동이상급심포적액；유심장초성의사중복검사이평개TTE질량급중증의학의사해석적준학성.결과 중증의학의사성공완성료86례환자(97.7％)적TTE검사,정학해석료75례환자(85.2％)적초성심동도결과；TTE검사결과직접영향료22.7％환자적치료(포괄액체치료、정성기력약물급혈관활성약물),45.5％환자획득유개치적신식,31.8％환자몰유득도유용적신식；중증의학의사획득도상화해석적평균시간위(11.2±5.2) min.결론 경과단잠적정규훈련,중증의학의사가이가고지완성ICU위중증환자적TTE검사,능구위상당수량적환자제공신적신식병개변기치료.저항연구지지재국내중증의학의사배훈과정중가입상방TTE검사배훈.
Objective To assess the clinical applicability of focused transthoracic echocardiography (TTE) in intenhsive care unit (ICU) performed by intensivists and its impacts on clinical managements.Methods After 12-hour tutorials and initial cardiac clinical assessments,intensivists performed a focused TTE (2-4 views of 2D,without Doppler or M mode) examination in 88 patients to assess left ventricular function and left ventricular volume status,and rule out local ventricular wall motion abnormalities and significant pencardial effusions.Each investigation was immediately reviewed by an echocardiographer to determine the technical quality of the TTE and the accuracy of the intensivist's interpretation.Results Intensivists successfully performed a diagnostic focused TTE in 86 patients (97.7%％) and interpreted correctly in 75 patients (85.2％).Management including fluid treatment,inotropic agent and vasoactive agent in 22.7％ of patients were changed directly based on the focused TTE,45.5％ of patients were provided with valuable information.while 31.8％ of them with non-valuable information.The mean focused TTE acquisition time of the intensivist was (11.2± 5.2) minutes.Conclusions After a brief standard training in using echocardiographic system,intensivists can successfully performed and correctly interpreted a focused TTE for critically ill patients.Our study demonstrates that new information can be provided by focused TTE,which can alter management in a significant number of patients.The present study supports incorporating bedside goal-directed,focused TTE into intensivists'training programs in China.