The application value of repeated-extended focused assessment with sonography for trauma in emergency ICU
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摘要: 目的:探讨重复扩展创伤重点超声评估技术(E-FAST)在急诊ICU创伤患者中的应用价值。方法:采用前瞻性研究方法,选择2019年1月—2020年10月期间收住急诊ICU的外伤患者178例。对患者每日均进行重复E-FAST检查,分别对重复3 d(R3-EFAST)及7 d(R7-EFAST)检查结果进行分析。以临床诊断为金标准,比较E-FAST及重复E-FAST检查技术对创伤患者的诊断效能。结果:178例创伤患者,每例患者检查胸腔积液、气胸、心包积液、脾脏损伤、肝脏损伤、肾脏损伤、胰腺损伤、腹膜血肿等8类损伤情况,共计1424个检查结果。临床诊断显示共262例脏器损伤,其中41例(占2.9%)为迟发性损伤,大多数发生在外伤后1~3 d。R3-EFAST及R7-EFAST检查对外伤患者器官损伤的诊断符合率、敏感度、特异度、准确度、阳性预测值及阴性预测值均高于E-FAST(P<0.05)。R3-EFAST与R7-EFAST诊断效能相仿。结论:重复扩展创伤重点超声检查具有快速、可重复、无创的优势,有利于外伤后脏器损伤的早期诊断,早期干预。连续3 d重复E-FAST检查可以发现迟发性器官损伤,减少漏诊,相比较连续7 d E-FAST检查更加具有成本效益优势。
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关键词:
- 扩展创伤重点超声评估 /
- 外伤 /
- 迟发性损伤 /
- 急诊
Abstract: Objective: To investigate the application value of repeated-extended focused assessment with sonography for trauma(E-FAST) in patients with trauma in emergency ICU.Methods: A prospective study was conducted to analyze 178 trauma patients admitted to the emergency ICU from January 2019 to October 2020. E-FAST examinations were repeated daily for all patients, and the results of repeated 3-day(R3-EFAST) and 7-day(R7-EFAST) examinations were analyzed respectively. Using the clinical diagnosis as the gold standard, the accuracy, sensitivity, specificity, positive predictive value and negative predictive value of E-FAST and repeated E-FAST were compared.Results: Each patient was examined for 8 types of injuries, including pleural effusion, pneumothorax, pericardial effusion, spleen injury, liver injury, kidney injury, pancreas injury and peritoneal hematoma. A total of 1424 examination results were obtained from these 178 trauma patients. The clinical diagnosis showed 262 cases of organ injury. In these 262 cases, the incidence of delayed injury was 2.9%(41/1424), most of which occurred 1 to 3 days after the trauma. The diagnostic coincidence rate, sensitivity, specificity, accuracy, positive predictive value and negative predictive value of R3-EFAST and R7-EFAST were higher than those of E-FAST(P<0.05). The diagnostic efficacy of R3-EFAST and R7-EFAST were similar.Conclusion: Repeated E-FAST has the advantages of rapid, repeatable and non-invasive, which are beneficial to the early diagnosis and treatment of organ injury. R3-EFAST can detect delayed injury and reduce missed diagnosis, which is more cost-effective than R7-EFAST. -
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