中国医药
中國醫藥
중국의약
China Medicine
2015年
11期
1651-1653
,共3页
李杰宾%朱捷%王宇%杜庆霞%丁宁
李傑賓%硃捷%王宇%杜慶霞%丁寧
리걸빈%주첩%왕우%두경하%정저
创伤性气胸%超声%急诊
創傷性氣胸%超聲%急診
창상성기흉%초성%급진
Traumatic pneumothorax%Ultrasound%Emergency
目的 探讨急诊医师应用床旁超声诊断创伤性气胸的价值.方法 选择2012年1月至2014年8月于首都医科大学附属北京同仁医院急诊科就诊的多发伤患者112例,入选患者在3h内完成床旁超声、X线及胸部CT检查.记录超声、X线及CT诊断气胸的部位、数量及耗时,以CT结果为"金标准",比较超声和X线诊断结果与"金标准"的一致性,并比较超声与X线诊断气胸的效能.结果 23例(26侧)经CT诊断为气胸,应用床旁超声诊断气胸24侧,误诊1侧,漏诊3侧;应用X线诊断气胸14侧,漏诊12侧.超声诊断气胸结果与CT结果差异无统计学意义(P =0.625),X线诊断气胸结果与CT结果差异有统计学意义(P＜0.01).超声对创伤性气胸诊断的敏感度、准确率、阴性预测值优于X线[88.5％(95％置信区间:68.7％ ～ 96.9％)比53.8％(95％置信区间:33.7％ ～ 72.9％),98.2％(95％置信区间:97.3％ ～99.9％)比94.6％(95％置信区间:91.7％～97.6％),98.5％(95％置信区间:95.3％～99.8％)比94.3％(95％置信区间:90.0％ ～ 96.9％)],差异有统计学意义(P＜0.05).CT诊断位于前胸部的气胸12侧,其中超声漏诊3侧,X线全部漏诊.超声诊断耗时明显少于胸部X线及CT[(6.8±1.6) min比(23.2±5.1)、(32.8 ±6.8)min],差异有统计学意义(P＜0.01).结论 急诊医师应用床旁超声检查对创伤性气胸的诊断效能与CT相似,且敏感度、准确率优于胸部X线.
目的 探討急診醫師應用床徬超聲診斷創傷性氣胸的價值.方法 選擇2012年1月至2014年8月于首都醫科大學附屬北京同仁醫院急診科就診的多髮傷患者112例,入選患者在3h內完成床徬超聲、X線及胸部CT檢查.記錄超聲、X線及CT診斷氣胸的部位、數量及耗時,以CT結果為"金標準",比較超聲和X線診斷結果與"金標準"的一緻性,併比較超聲與X線診斷氣胸的效能.結果 23例(26側)經CT診斷為氣胸,應用床徬超聲診斷氣胸24側,誤診1側,漏診3側;應用X線診斷氣胸14側,漏診12側.超聲診斷氣胸結果與CT結果差異無統計學意義(P =0.625),X線診斷氣胸結果與CT結果差異有統計學意義(P＜0.01).超聲對創傷性氣胸診斷的敏感度、準確率、陰性預測值優于X線[88.5％(95％置信區間:68.7％ ～ 96.9％)比53.8％(95％置信區間:33.7％ ～ 72.9％),98.2％(95％置信區間:97.3％ ～99.9％)比94.6％(95％置信區間:91.7％～97.6％),98.5％(95％置信區間:95.3％～99.8％)比94.3％(95％置信區間:90.0％ ～ 96.9％)],差異有統計學意義(P＜0.05).CT診斷位于前胸部的氣胸12側,其中超聲漏診3側,X線全部漏診.超聲診斷耗時明顯少于胸部X線及CT[(6.8±1.6) min比(23.2±5.1)、(32.8 ±6.8)min],差異有統計學意義(P＜0.01).結論 急診醫師應用床徬超聲檢查對創傷性氣胸的診斷效能與CT相似,且敏感度、準確率優于胸部X線.
목적 탐토급진의사응용상방초성진단창상성기흉적개치.방법 선택2012년1월지2014년8월우수도의과대학부속북경동인의원급진과취진적다발상환자112례,입선환자재3h내완성상방초성、X선급흉부CT검사.기록초성、X선급CT진단기흉적부위、수량급모시,이CT결과위"금표준",비교초성화X선진단결과여"금표준"적일치성,병비교초성여X선진단기흉적효능.결과 23례(26측)경CT진단위기흉,응용상방초성진단기흉24측,오진1측,루진3측;응용X선진단기흉14측,루진12측.초성진단기흉결과여CT결과차이무통계학의의(P =0.625),X선진단기흉결과여CT결과차이유통계학의의(P＜0.01).초성대창상성기흉진단적민감도、준학솔、음성예측치우우X선[88.5％(95％치신구간:68.7％ ～ 96.9％)비53.8％(95％치신구간:33.7％ ～ 72.9％),98.2％(95％치신구간:97.3％ ～99.9％)비94.6％(95％치신구간:91.7％～97.6％),98.5％(95％치신구간:95.3％～99.8％)비94.3％(95％치신구간:90.0％ ～ 96.9％)],차이유통계학의의(P＜0.05).CT진단위우전흉부적기흉12측,기중초성루진3측,X선전부루진.초성진단모시명현소우흉부X선급CT[(6.8±1.6) min비(23.2±5.1)、(32.8 ±6.8)min],차이유통계학의의(P＜0.01).결론 급진의사응용상방초성검사대창상성기흉적진단효능여CT상사,차민감도、준학솔우우흉부X선.
Objective To investigate the value of emergency bedside ultrasound (US) in diagnosing traumatic pneumothorax (PTX).Methods Totally 112 patients with multiple trauma in emergency department from January 2012 to August 2014 were enrolled.All the patients underwent bedside US, X-ray and chest CT within 3 hours.The PTX location, number of PTX and time-consuming of examination were recorded respectively.Taking chest CT scan as the gold standard, the diagnostic ability of bedside US, X-ray and chest CT was compared.Results There were 23 cases (26 sides) were diagnosed as PTX by chest CT.There were 24 sides PTX being diagnosed by bedside US, including 1 side being misdiagnosed;3 sides were missed by bedside US.There were 14 sides PTX being diagnosed by chest X-ray, 16 sides were missed.The number of PTX diagnosed by US and chest CT had no significant difference (P =0.625), but the number of PTX diagnosed by X-ray was significantly less than that by CT (P ＜ 0.01).The sensitivity, accuracy and negative predictive value of US in diagnosing traumatic PTX were significantly higher than those of chest X-ray [88.5％ (95％ confidence inferval: 68.7％-96.9％) vs 53.8％ (95％ confidence inferval: 33.7％-72.9％) , 98.2％ (95％ confidence inferval: 97.3％-99.9％) vs 94.6％ (95％ confidence inferval: 91.7％-97.6％), 98.5％ (95％ confidence inferval: 95.3％-99.8％) vs 94.3％ (95％ confidence inferval: 90.0％-96.9％)] (P ＜0.05).In 12 sides PTX located in anterior chest diagnosed by CT, 3 were missed by US and all were missed by X-ray.The diagnostic time-consuming of US was shorter than that of X-ray and CT [(6.8 ± 1.6) min vs (23.2 ± 5.1), (32.8 ± 6.8) min](P ＜ 0.01).Conclusion Bedside thoracic US performed by well-trained emergency physicians has similar ability as chest CT in diagnosing traumatic PTX, showing a better feasibility than chest X-ray.
