CAJ | 학술논문

目的探讨急诊床旁针对创伤的重点超声评估(focused assessment with sonography for trauma,FAST)技术结合区域脏器重点超声检查在腹部闭合性创伤患者中的应用价值. 方法我院急诊科内行床旁超声检查的腹部闭合性创伤患者237例.对于血流动力学不稳定或伴有重型颅脑损伤患者,FAST筛查后立即结束超声检查；对于生命体征平稳的患者,FAST筛查后根据致伤机制、致伤的外力作用部位及方向、患者腹部症状与体征确定重点扫查区域,对相应脏器进行创伤检查.以手术及CT扫描结果作为金标准与超声检查结果进行比较. 结果 (1)FAST技术对于腹腔脏器破裂伤、需紧急手术的腹腔脏器破裂伤所至腹腔积液的诊断敏感度分别为79.3％、100％；FAST技术总的特异度为98.2％,阳性预测值93.9％,阴性预测值为86.7％.(2)区域脏器重点超声检查单脏器损伤超声诊断符合率为91.2％；多脏器损伤超声诊断符合率为63.6％；漏诊以挫伤及脏器细小裂伤为主. 结论 FAST技术可快速筛查需紧急处理的腹腔脏器破裂导致血流动力学不稳定的患者.区域脏器重点超声检查可提高脏器损伤诊断符合率,减少漏诊.
목적 탐토급진상방침대창상적중점초성평고(focused assessment with sonography for trauma,FAST)기술결합구역장기중점초성검사재복부폐합성창상환자중적응용개치. 방법 아원급진과내행상방초성검사적복부폐합성창상환자237례.대우혈류동역학불은정혹반유중형로뇌손상환자,FAST사사후립즉결속초성검사；대우생명체정평은적환자,FAST사사후근거치상궤제、치상적외력작용부위급방향、환자복부증상여체정학정중점소사구역,대상응장기진행창상검사.이수술급CT소묘결과작위금표준여초성검사결과진행비교. 결과 (1)FAST기술대우복강장기파렬상、수긴급수술적복강장기파렬상소지복강적액적진단민감도분별위79.3％、100％；FAST기술총적특이도위98.2％,양성예측치93.9％,음성예측치위86.7％.(2)구역장기중점초성검사단장기손상초성진단부합솔위91.2％；다장기손상초성진단부합솔위63.6％；루진이좌상급장기세소렬상위주. 결론 FAST기술가쾌속사사수긴급처리적복강장기파렬도치혈류동역학불은정적환자.구역장기중점초성검사가제고장기손상진단부합솔,감소루진.
Objective To investigate the value of emergency bedside focused assessment with sonography for trauma (FAST) in combination with regional organ focused ultrasonography in patients with closed abdominal trauma.Methods Two hundred and thirty-seven patients with closed abdominal trauma underwent bedside ultrasonography in the Emergency Department at General Hospital of Chengdu Military Command.In patients with unstable hemodynamics or severe craniocerebral injury,ultrasonography was ended immediately after FAST screening.In patients with stable vital signs,the focused regional organ injury after FAST screening was determined based on the mechanism of trauma,action location and direction of external force,abdominal symptoms,and signs.The results of operation and CT scanning were considered as golden criteria and used to compare with those of ultrasonography.Results (1) The diagnostic sensitivity of FAST to abdominal organ rupture and ascites due to abdominal organ rupture calling for emergency operation was 79.3％ and 100％,respectively.The total specificity of FAST was 98.2％,positive predictive value 93.9％,and negative predictive value 86.7％.(2) The diagnostic accordance rate of single visceral injury examined by regional organ focused ultrasonography was 91.2％ and that of multiple visceral injury was 63.6％.The missed diagnoses were predominantly contusion and microlaceration.Conclusions FAST can quickly screen out the patients with unstable hemodynamics due to abdominal organ rupture calling for emergency management.Regional organ focused ultrasonography can increase the rate of correct diagnosis of visceral injury and decrease the rate of missed diagnosis.