Application value of critical ultrasound falls procedure in early identification of shock types
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摘要: 目的 探讨急诊科医生应用重症超声FALLS流程在休克类型早期识别的效果及可行性。方法 选取南昌大学第二附属医院急诊科2018年5月-2020年6月期间收治的休克患者210例，在不耽误这些患者救治前提下，观察组由经过重症超声培训合格的急诊科医生按照肺部超声指导的液体管理(FALLS)流程对这210例患者实行床旁超声探查测量，同时对照组由高年资超声科医生对这210例患者按照常规超声流程探查测量，以最终的临床诊断(症状、体征、既往史及辅助检查)为金标准，对比分析两组不同超声方法诊断休克类型的诊断时间与诊断效能。结果 观察组诊断时间为平均(8.32±1.03) min，对照组诊断时间为平均(12.36±1.11) min，观察组诊断时间较对照组显著缩短，差异均有统计学意义(P< 0.05);观察组诊断休克类型的敏感度为100%，观察组诊断结果的敏感度和阳性预测值均高于对照组(100.00% vs.91.46%，21.09% vs.3.91%，均P< 0.05);进一步揭示两组的诊断效能，观察组诊断休克类型的AUC(0.851)高于对照组(0.575)，差异有统计学意义(P< 0.05)。结论 急诊科医生应用重症超声FALLS流程对休克患者进行检查测量，有助于快速评估和明确早期休克类型，值得临床推广应用。Abstract: Objective To investigate the effect and feasibility of emergency doctors'application of critical ultrasound FALLS procedure in the early identification of shock types.Methods From May 2018 to June 2020, 210 shock patients in the emergency department of the Second Affiliated Hospital of Nanchang University were selected. On the premise of not delaying the treatment of these patients, the observation group was carried out bedside ultrasound exploration on these 210 patients by emergency doctors who have received intensive ultrasound training and qualified according to the FALLS process; while the control group were detected and measured by senior ultrasound doctors according to the conventional ultrasound process. Taking the final clinical diagnosis(symptoms, signs, history and auxiliary examinations) as the gold standard, the diagnostic time and diagnostic efficiency of different ultrasonic methods were compared and analyzed.Results The average diagnosis time was(8.32±1.03) min in the observation group and(12.36±1.11) min in the control group. The diagnosis time in the observation group was significantly shorter than that in the control group(P< 0.05). The sensitivity of the observation group to diagnose the type of shock was 100%, and the diagnostic sensitivity and positive predictive value of the observation group were higher than those of the control group(100.00% vs. 91.46%, 21.09% vs. 3.91%,P< 0.05). Further revealing the diagnostic efficacy of the two groups, the AUC of the diagnostic shock type in the observation group(0.851) was higher than that in the control group(0.575), and the difference was statistically significant(P< 0.05).Conclusion The critical ultrasound FALLS procedure is utilized by emergency physicians to examine shock patients, which contributes to quickly evaluating and defining the types of early shock, and promote its clinical application.
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Key words:
- critical ultrasound /
- FALLS procedure /
- emergency department /
- shock /
- identification
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表 1 FALLS、常规超声与辅助检查或临床诊断结果比较
例 辅助检查或临床诊断结果 例数 FALLS 常规超声 阳性 阴性 阳性 阴性 阳性 82 82 0 75 7 阴性 128 27 101 5 123 合计 210 109 101 80 130 
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[1] 姜志钊, 刘玉琪, 任建安. 液体治疗降阶梯策略在腹腔脓毒性休克中的应用进展[J]. 中华危重病急救医学, 2020, 32(11): 1403-1408. doi: 10.3760/cma.j.cn121430-20200714-00519
[2] Brown SM, Kasal J. Bedside Ultrasound in the Intensive Care Unit: Where Is the Evidence?[J]. Semin Respir Crit Care Med, 2015, 36(6): 878-889. doi: 10.1055/s-0035-1564873
[3] 曹钰, 晁彦公, 张国强, 等. 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. doi: 10.3760/cma.j.issn.1671-0282.2016.01.005
[4] Lichtenstein DA. BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill[J]. Chest, 2015, 147(6): 1659-1670. doi: 10.1378/chest.14-1313
[5] Lichtenstein DA, Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol[J]. Chest, 2008, 134(1): 117-125. doi: 10.1378/chest.07-2800
[6] Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016[J]. Crit Care Med, 2017, 45(3): 486-552.
[7] 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. http://zzlc.cbpt.cnki.net/WKC/WebPublication/paperDigest.aspx?paperID=0b239c6d-46e5-4a9d-8721-7e2bef341fa2
[8] 胡翔宇, 李力, 郝晓晔, 等. 被动抬腿试验联合超声心动图评价感染性休克患者的容量反应性[J]. 中华危重病急救医学, 2019, 31(5): 619-622. doi: 10.3760/cma.j.issn.2095-4352.2019.05.019
[9] Perera P, Mailhot T, Riley D, et al. The RUSH exam: Rapid Ultrasound in SHock in the evaluation of the critically lll[J]. Emerg Med Clin North Am, 2010, 28(1): 29-56.
[10] 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. doi: 10.3760/cma.j.issn.1671-0282.2017.05.004
[11] 原娇娇, 杨晓玲, 袁琪茜, 等. 基于脓毒性休克患者超声引导下液体复苏与早期目标导向治疗复苏效果的系统评价[J]. 中华危重病急救医学, 2020, 32(1): 56-61. doi: 10.3760/cma.j.cn121430-20191114-00010
[12] 余琨, 陈妮, 张伟, 等. 重症超声在脓毒性休克血流动力学监测中的应用价值[J]. 中华危重病急救医学, 2019, 31(2): 248-251.
[13] Lee C W, Kory P D, Arntfield R T. Development of a fluid resuscitation protocol using inferior vena cava and lung ultrasound[J]. J Crit Care, 2016, 31(1): 96-100. doi: 10.1016/j.jcrc.2015.09.016
[14] Basnet S, Shrestha SK, Pradhan A, et al. Diagnostic performance of the extended focused assessment with sonography for trauma (EFAST) patients in a tertiary care hospital of Nepal[J]. Trauma Surg Acute Care Open, 2020, 5(1): e000438.
[15] 顾鹏, 李峰, 刘颖, 等. 重复扩展创伤重点超声评估技术在急诊ICU的应用价值[J]. 临床急诊杂志, 2021, 22(6): 373-376. http://zzlc.cbpt.cnki.net/WKC/WebPublication/paperDigest.aspx?paperID=5298320f-9105-4f92-9b29-bac7403713f5
[16] Valenzuela J, Stilson B, Patanwala A, et al. Prevalence, documentation, and communication of incidental findings in focused assessment with sonography for trauma (FAST) examinations[J]. Am J Emerg Med, 2020, 38(7): 1414-1418.
[17] 孙艳, 周婷, 卓荦, 等. 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[J]. 临床急诊杂志, 2019, 20(6): 471-474. http://zzlc.cbpt.cnki.net/WKC/WebPublication/paperDigest.aspx?paperID=f12be8af-eec1-442b-80fc-16548f6ff0ac
[18] 史迪, 张秋彬, 曹广慧. 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. doi: 10.3760/cma.j.issn.1671-0282.2017.05.004
[19] 张运玮, 曹春艳, 张进祥. 心肺联合超声结合临床评估在急诊科诊断急性心衰的研究[J]. 临床急诊杂志, 2021, 22(8): 553-557. http://zzlc.cbpt.cnki.net/WKC/WebPublication/paperDigest.aspx?paperID=067b7e30-958f-4ac2-8738-9ede55c01d8a
[20] 张丽娜, 张宏民, 王小亭, 等. 精准休克治疗: 要重视重症超声导向的六步法休克评估流程[J]. 中华医学杂志, 2016, 96(29): 2289-2291. doi: 10.3760/cma.j.issn.0376-2491.2016.29.001
[21] 刘昌, 刘彤, 张靖垚. 从新型冠状病毒肺炎诊疗指南更新谈对新型冠状病毒肺炎的认知过程[J]. 西安交通大学学报(医学版), 2021, 42(2): 333-338. https://www.cnki.com.cn/Article/CJFDTOTAL-XAYX202102032.htm
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