CAJ | 학술논문

目的探讨急诊科医生使用便携式超声评估左心室收缩功能的准确性.方法前瞻性、观察性研究,连续选取2011年11月至2012年2月期间以急性呼吸困难主诉收入上海交通大学医学院附属新华医院急诊科的81例患者,排除创伤和急性心肌梗死患者.4名急诊科医生经过强化超声心动图培训后,使用便携式超声仪对81例患者行床旁超声心动图检查,获取左胸骨旁长短轴、心尖四腔和剑突下二维图像,使用目测法估计左心室射血分数,将患者左心室收缩功能分为正常、轻中度减低和严重减低三个类别,与超声科医生的超声心动图测量结果相比较.使用SPSS13.0统计软件进行kappa检验来分析二者的诊断一致性.结果以超声科医生测量的左心室射血分数为“金标准”,急诊科医生区分左心室收缩功能正常和减低的准确率为89％,急诊科医生判断患者左心室收缩功能减低的阳性预测值为83％,阴性预测值为93％,急诊科医生和超声科医生诊断一致性检验kappa系数为0.77 (95％CI:0.70～0.84,P＜0.01).对左心室收缩功能三个不同类别的判断,急诊科医生的准确率为84％,诊断一致性检验kappa系数为0.71(95％CI:0.64 ～0.78,P＜0.01).结论急诊科医生经过超声心动图强化培训后,使用便携式超声仪能够准确地评估左心室收缩功能.
목적 탐토급진과의생사용편휴식초성평고좌심실수축공능적준학성.방법 전첨성、관찰성연구,련속선취2011년11월지2012년2월기간이급성호흡곤난주소수입상해교통대학의학원부속신화의원급진과적81례환자,배제창상화급성심기경사환자.4명급진과의생경과강화초성심동도배훈후,사용편휴식초성의대81례환자행상방초성심동도검사,획취좌흉골방장단축、심첨사강화검돌하이유도상,사용목측법고계좌심실사혈분수,장환자좌심실수축공능분위정상、경중도감저화엄중감저삼개유별,여초성과의생적초성심동도측량결과상비교.사용SPSS13.0통계연건진행kappa검험래분석이자적진단일치성.결과 이초성과의생측량적좌심실사혈분수위“금표준”,급진과의생구분좌심실수축공능정상화감저적준학솔위89％,급진과의생판단환자좌심실수축공능감저적양성예측치위83％,음성예측치위93％,급진과의생화초성과의생진단일치성검험kappa계수위0.77 (95％CI:0.70～0.84,P＜0.01).대좌심실수축공능삼개불동유별적판단,급진과의생적준학솔위84％,진단일치성검험kappa계수위0.71(95％CI:0.64 ～0.78,P＜0.01).결론 급진과의생경과초성심동도강화배훈후,사용편휴식초성의능구준학지평고좌심실수축공능.
Objective To determine the capability of emergency physicians (EPs) after goaldirected training to make accurate judgement and assessment of left ventricular systolic function (LVSF) as they own manipulated the hand-held echocardiography.Methods Eighty-one patients with acute dyspneic symptom admitted into emergency department of Xinhua Hospital Affiliated to Shanghai qaotong University School of Medicine from November 2011 to February 2012 were enrolled for a prospective,observational study.Patients with a history of trauma or acute myocardial infarction diagnosed by electrocardiogram were excluded.Four EPs after a intensive course of goal-oriented training in a good command of trans-thoracic echocardiography (TTE) in 81 emergency patients using hand-held echocardiography.EPs attempted to obtain images at the parasternal (long and short axis),apical,and subcostal positions,and visually estimated left ventricular ejection fraction (LVEF) and categorized LVSF as normal function,mild or moderate or severely depressed function.The results of echocardiographic LVEF got by EPs were compared quntitatively with those measured by an professional echocardiographer.The kappa statistical test by using SPSS version 13.0 software was used to allow for comparison in agreement between EPs and the professional echocardiographer's interpretations of TTE findings.Results Using the results of TTE measured by the professional echocardiographer as a " gold standard",EPs correctly distinguished the normal LVSF from decreased LVSF in 89％ patients.The rate of positive predictive value for the EPs identifying any abnormality in LV function was 83％ and the rate of negative predictive value was 93％.The kappa coefficient for the agreement between EPs and the professional echocardiographer' s interpretations for any abnormality in LV function was 0.77 (95％ CI:0.70-0.84,P ＜ 0.01).EPs correctly placed LV function into one of three categories in 68 of 81 cases (84％),The kappa coefficient for the agreement was 0.71 (95％ CI:0.64-0.78,P ＜0.01).Conclusions Emergency physicians after a intensive course of training in mastering echocardiography can accurately determine the left ventricular systolic function.