急诊科医生应用床旁超声抢救不明原因休克的效果及可行性分析
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摘要
目的:探讨急诊科医生应用床旁超声抢救不明原因休克的效果及可行性。方法:我院自2017-07-01开始在急诊抢救室由经过重症超声培训合格的急诊科医生应用床旁超声对急危重症患者进行救治。对不明原因休克患者的探查按照《不明原因休克急诊超声临床实践专家共识》推荐的THIRD流程进行。本文采用回顾性分析我院急诊科2016-01-01-2018-08-31收治的不明原因休克患者,其中123例由超声科医生实行床旁超声探查,称为超声医生组,159例由急诊科医生按此方案实行床旁超声探查,称为急诊医生组。对比分析两组患者诊断时间,计算急诊医生组诊断敏感性、特异性、阳性预测值、阴性预测值以及总准确率等指标。结果:急诊医生组诊断时间较超声组显著缩短,差异均有统计学意义(P<0.05);急诊医生组患者敏感性、特异性、阳性预测值、阴性预测值及总准确率较高。结论:急诊科医生应用床旁超声按照THIRD流程探查不明原因休克患者,有助于快速明确诊断,诊断效率及准确性高,提倡推广应用。
Objective: To investigate the effect and feasibility bedside ultrasound in treatment of patients with shock of unknown origin in emergency department. Method: In our emergency department, from July 1 st 2017, emergency doctors received training on bedside ultrasound examining. Examination of patients with shock of unknown origin was carried out according to THIRD process recommended by the expert consensus on emergency ultrasound clinical practice for shock of unknown origin. This article retrospectively analyzed patients with shock of unknown origin registered in our emergency department from January 1 2016 to August 31 2018. Among them, ultrasound doctor group contains 123 patients who received bedside ultrasound exploration by a sonographer. Emergency doctor group contains 159 patients who received bedside ultrasound examination by emergency doctors according to THIRD process. Time for diagnosis was compared between the two groups. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value and total accuracy were calculated. Result: Time for diagnosis in emergency doctor group was shorter than that in ultrasound doctor group, difference was statistically significant(P<0.05). The sensitivity, specificity, positive predictive value, negative predictive value and total accuracy in emergency doctor group were encouraging. Conclusion: It helps to ascertain the cause of shock more quickly, improve diagnostic efficiency and accuracy that emergency doctors use bedside ultrasound to due patients with shock of unknown origin according to THIRD process. It should be widely applicated.
Objective: To investigate the effect and feasibility bedside ultrasound in treatment of patients with shock of unknown origin in emergency department. Method: In our emergency department, from July 1 st 2017, emergency doctors received training on bedside ultrasound examining. Examination of patients with shock of unknown origin was carried out according to THIRD process recommended by the expert consensus on emergency ultrasound clinical practice for shock of unknown origin. This article retrospectively analyzed patients with shock of unknown origin registered in our emergency department from January 1 2016 to August 31 2018. Among them, ultrasound doctor group contains 123 patients who received bedside ultrasound exploration by a sonographer. Emergency doctor group contains 159 patients who received bedside ultrasound examination by emergency doctors according to THIRD process. Time for diagnosis was compared between the two groups. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value and total accuracy were calculated. Result: Time for diagnosis in emergency doctor group was shorter than that in ultrasound doctor group, difference was statistically significant(P<0.05). The sensitivity, specificity, positive predictive value, negative predictive value and total accuracy in emergency doctor group were encouraging. Conclusion: It helps to ascertain the cause of shock more quickly, improve diagnostic efficiency and accuracy that emergency doctors use bedside ultrasound to due patients with shock of unknown origin according to THIRD process. It should be widely applicated.
引文
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[12] Nazerian P,Vanni S,Morello F,et al.Diagnostic performance of focused cardiac ultrasound performed by emergency physicians for the assessment of ascending aorta dilation and aneurysm[J].Acad Emerg Med,2015,22(5):536-541.
[13] Hasani SA,Fathi M,Daadpey M,et al.Accuracy of bedside emergency physician performed ultrasound in diagnosing different causes of acute abdominal pain:a prospective study[J].Clin Imaging,2015,39(3):476-479.
[14] Hassen GW,Bruck I,Donahue J,et al.Accuracy of optic nerve sheath diameter measurement by emergency physicians using bedside ultrasound[J].J Emerg Med,2015,48(4):450-457.
[15] 梅勇,陈旭锋,黄培培,等.床旁肺部超声对急性呼吸衰竭病因的诊断价值[J].临床急诊杂志,2016,17(8):634-636.
[16] Shi D,Walline JH,Yu X,et al.Evaluating and assessing the prevalence of bedside ultrasound in emergency departments in China[J].J Thorac Dis,2018,10(5):2685-2690.
[17] Charron C,Templier F,Goddet NS,et al.Difficulties encountered by physicians in interpreting focused echocardiography using a pocket ultrasound machine in prehospital emergencies[J].Eur J Emerg Med,2015,22(1):17-22.
[2] Inglis AJ,Nalos M,Sue KH,et al.Bedside lung ultrasound,mobile radiography and physical examination:a comparative analysis of diagnostic tools in the critically ill[J].Crit Care Resusc,2016,18(2):124.
[3] 不明原因休克急诊超声临床实践专家共识组.不明原因休克急诊超声临床实践专家共识[J].中华急诊医学杂志,2017,26(5):498-506.
[4] 床旁超声在急危重症临床应用专家共识组.床旁超声在急危重症临床应用的专家共识[J].中华急诊医学杂志,2016,25(1):10-21.
[5] Morgan BB,Kao A,Trent SA,et al.Effect of Emergency physician-performed point-of-care ultrasound and radiology department-performed ultrasound examinations on the emergency department length of stay among pregnant women at less than 20 weeks' gestation[J].J Ultrasound Med,2018,37(11):2497-2505.
[6] Baker N,Amini R,Situ-Lacasse EH,et al.Can emergency physicians accurately distinguish retinal detachment from posterior vitreous detachment with point-of-care ocular ultrasound?[J].Am J Emerg Med,2018,36(5):774-776.
[7] Duran-Gehring P,Bryant L,Reynolds JA,et al.Ultrasound-Guided Peripheral Intravenous Catheter Training Results in Physician-Level Success for Emergency Department Technicians[J].J Ultrasound Med,2016,35(11):2343-2352.
[8] 杨伟强,龚好,徐欣晖,等.超声引导下颈内静脉穿刺置管术在急诊危重症患者中的应用[J].临床急诊杂志,2015,16(11):858-860,866.
[9] Sawe HR,Haeffele C,Mfinanga JA,et al.Predicting fluid responsiveness using bedside ultrasound measurements of the inferior vena cava and physician gestalt in the emergency department of an urban public hospital in Sub-Saharan Africa[J].PloS One,2016,11(9):e0162772.
[10] Topin F,Thierry AL,Catrevaux O,et al.Diagnostic accuracy of emergency physician-performed ultrasound for acute appendicitis in a remote location[J].J Emerg Med,2016,50(6):859-867.
[11] Pare JR,Liu R,Moore CL,et al.Emergency physician focused cardiac ultrasound improves diagnosis of ascending aortic dissection[J].Am J Emerg Med,2016,34(3):486-492.
[12] Nazerian P,Vanni S,Morello F,et al.Diagnostic performance of focused cardiac ultrasound performed by emergency physicians for the assessment of ascending aorta dilation and aneurysm[J].Acad Emerg Med,2015,22(5):536-541.
[13] Hasani SA,Fathi M,Daadpey M,et al.Accuracy of bedside emergency physician performed ultrasound in diagnosing different causes of acute abdominal pain:a prospective study[J].Clin Imaging,2015,39(3):476-479.
[14] Hassen GW,Bruck I,Donahue J,et al.Accuracy of optic nerve sheath diameter measurement by emergency physicians using bedside ultrasound[J].J Emerg Med,2015,48(4):450-457.
[15] 梅勇,陈旭锋,黄培培,等.床旁肺部超声对急性呼吸衰竭病因的诊断价值[J].临床急诊杂志,2016,17(8):634-636.
[16] Shi D,Walline JH,Yu X,et al.Evaluating and assessing the prevalence of bedside ultrasound in emergency departments in China[J].J Thorac Dis,2018,10(5):2685-2690.
[17] Charron C,Templier F,Goddet NS,et al.Difficulties encountered by physicians in interpreting focused echocardiography using a pocket ultrasound machine in prehospital emergencies[J].Eur J Emerg Med,2015,22(1):17-22.