中华内科杂志
中華內科雜誌
중화내과잡지
CHINESE JOURNAL OF INTERNAL MEDICINE
2014年
10期
793-798
,共6页
王小亭%赵华%刘大为%张宏民%杜微%柴文昭%张青%晁彦公%尹万红
王小亭%趙華%劉大為%張宏民%杜微%柴文昭%張青%晁彥公%尹萬紅
왕소정%조화%류대위%장굉민%두미%시문소%장청%조언공%윤만홍
超声检查%重症超声%危重病%病因评估
超聲檢查%重癥超聲%危重病%病因評估
초성검사%중증초성%위중병%병인평고
Ultrasonography%Critical care ultrasonography%Critical illness%Cause of critically ill status
目的 探讨北京协和医院重症超声管理(PCUM)方案在重症患者急性呼吸困难/血流动力学不稳定病因诊断中的作用.方法 选北京协和医院重症医学科突发呼吸困难/血流动力学不稳定者,在常规诊疗的同时应用PCUM方案初步判断病因,记录初始判断病因时间、初始正确治疗时间、确定诊断时间、初始诊断正确率,采用ROC曲线判断PCUM方案对主要病因诊断的特异性与敏感性.结果 129例患者入选本研究,其中呼吸困难者68例,血流动力学不稳定者18例,呼吸困难合并血流动力学不稳定者43例.PCUM方案对患者病因的初步诊断时间为(15 ±6) min,确定诊断时间(65±16) min,初始诊断正确率93.0％,采用初始正确治疗时间为(34±14) min.PCUM方案对急性呼吸窘迫综合征诊断的敏感性为90.2％,特异性为93.6％;对急性肺水肿的敏感性为93.4％,特异性为92.7％;对分布性休克的敏感性为92.5％,特异性为93.6％.结论 对ICU突发呼吸困难/血流动力学不稳定的重症患者,PCUM方案对病因的初步判断需时较短,诊断准确率较高,采用初始正确治疗的时间较短,值得临床推广,但对重症患者预后的影响尚待进一步研究.
目的 探討北京協和醫院重癥超聲管理(PCUM)方案在重癥患者急性呼吸睏難/血流動力學不穩定病因診斷中的作用.方法 選北京協和醫院重癥醫學科突髮呼吸睏難/血流動力學不穩定者,在常規診療的同時應用PCUM方案初步判斷病因,記錄初始判斷病因時間、初始正確治療時間、確定診斷時間、初始診斷正確率,採用ROC麯線判斷PCUM方案對主要病因診斷的特異性與敏感性.結果 129例患者入選本研究,其中呼吸睏難者68例,血流動力學不穩定者18例,呼吸睏難閤併血流動力學不穩定者43例.PCUM方案對患者病因的初步診斷時間為(15 ±6) min,確定診斷時間(65±16) min,初始診斷正確率93.0％,採用初始正確治療時間為(34±14) min.PCUM方案對急性呼吸窘迫綜閤徵診斷的敏感性為90.2％,特異性為93.6％;對急性肺水腫的敏感性為93.4％,特異性為92.7％;對分佈性休剋的敏感性為92.5％,特異性為93.6％.結論 對ICU突髮呼吸睏難/血流動力學不穩定的重癥患者,PCUM方案對病因的初步判斷需時較短,診斷準確率較高,採用初始正確治療的時間較短,值得臨床推廣,但對重癥患者預後的影響尚待進一步研究.
목적 탐토북경협화의원중증초성관리(PCUM)방안재중증환자급성호흡곤난/혈류동역학불은정병인진단중적작용.방법 선북경협화의원중증의학과돌발호흡곤난/혈류동역학불은정자,재상규진료적동시응용PCUM방안초보판단병인,기록초시판단병인시간、초시정학치료시간、학정진단시간、초시진단정학솔,채용ROC곡선판단PCUM방안대주요병인진단적특이성여민감성.결과 129례환자입선본연구,기중호흡곤난자68례,혈류동역학불은정자18례,호흡곤난합병혈류동역학불은정자43례.PCUM방안대환자병인적초보진단시간위(15 ±6) min,학정진단시간(65±16) min,초시진단정학솔93.0％,채용초시정학치료시간위(34±14) min.PCUM방안대급성호흡군박종합정진단적민감성위90.2％,특이성위93.6％;대급성폐수종적민감성위93.4％,특이성위92.7％;대분포성휴극적민감성위92.5％,특이성위93.6％.결론 대ICU돌발호흡곤난/혈류동역학불은정적중증환자,PCUM방안대병인적초보판단수시교단,진단준학솔교고,채용초시정학치료적시간교단,치득림상추엄,단대중증환자예후적영향상대진일보연구.
Objective To investigate the effects of Peking Union Medical College Hospital (PUMCH) Critical Ultrasonic Management (PCUM) scheme on the etiological diagnosis and treatment decisions for the patients with dyspnea and/or hemodynamic instability in ICU.Methods Patients who suffered from dyspnea and/or hemodynamic instability in PUMCH ICU were included in this study.The time to preliminary diagnosis,time to final diagnosis,diagnostic accuracy,time to accurate treatment,time to consultation with other specialties,time to other examinations were recorded.Results A total of 129 patients were included in this study.In patients applied with PCUM scheme,time to preliminary diagnosis,final diagnosis and accurate treatment were (15 ± 6)min,(65 ± 16)min and (34 ± 14)min respectively,and the accuracy of diagnosis was 93.0％.PCUM patients had high sensitivity and specificity for the diagnosis of acute respiratory distress syndrome (ARDS) (sensitivity 90.2％/specificity 93.6％),distributive shock (sensitivity 92.5％/specificity 93.6％) and pulmonary edema (sensitivity 93.4％/ specificity 92.7％) etc.Conclusions The PCUM scheme is associated with short time to preliminary diagnosis and high diagnostic accuracy and could improve the treatment for patients with dyspnea and/or hemodynamic instability.
