The Value of Bedside Ultrasound in Improving Treatment in ICU_West China Medical Journal

Authors：

YIN Wanhong , SHU Aiya , CHEN Yao , WANG Bo , ZUO Yanyan

Intensive care unit, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

Keywords：

床旁超聲; 重癥醫學; 診斷

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目的　探討床旁超聲在重癥監護治療決策中的價值及應用方案。方法　回顧2010年6月－2012年2月期間床旁超聲應用情況及提供的信息對治療決策的影響及臨床效果，總結重癥診治臨床實踐中可行的應用方案。結果　研究期間共使用床旁超聲219例次，其中血流動力學監測（評估心臟前負荷、收縮力）41例次，低氧原因檢查45例次，血栓篩查19例次，胎心監測22例次，引導深靜脈穿刺48例次，引導胸、腹腔穿刺及置管37例次，引導動脈置管4例次，氣道情況檢查3例次。循環監測中經驗判斷容量準確性為63.4%，床旁超聲能提供85.4%的正確信息，其中糾正了13例臨床經驗判斷錯誤（31.7%），明顯提高了診斷正確率（P＜0.05）；低氧原因判斷中臨床判斷正確率62.2%，超聲檢查能提供86.7%的正確信息，發現16例臨床經驗判斷錯誤，糾正錯誤判斷35.6% （P＜0.05）。結論　床旁超聲能很好地協助重癥醫學科醫生提高臨床判斷準確性，控制醫療風險。

Citation： YIN Wanhong,SHU Aiya,CHEN Yao,WANG Bo,ZUO Yanyan. The Value of Bedside Ultrasound in Improving Treatment in ICU. West China Medical Journal, 2012, 27(9): 1315-1318. doi: Copy

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1. 　Beaulieu Y, Marik PE. Bedside ultrasonography in the ICU: part 1[J].Chest, 2005, 128(2): 1766-1781.
2. 　Beaulieu Y, Bedside echocardiography in the assessment of the critically ill[J]. Crit Care Med, 2007, 35(5 suppl 1): 235-249.
3. 　Stefanidis K, Dimopoumos S, Nanas S. Basic principles and current applications of lung ultrasonography in the intensive care unit[J]. Respirology, 2011, 16(2): 249-256.
4. 　Salem R, Vallee F, Rusca M, et al. Hemodynamic monitoring by echocardiography in the ICU: the role of the new echo techniques[J]. Curr Opin Criti Care, 2008, 14(5): 561-568.
5. 　Vieillard-Baron A. Assessment of right ventricular function[J]. Curr Opin Crit Care, 2009, 15(3): 254-260.
6. 　Vieillard-Baron A, Jardin F. Why protect the right ventricle in patients with acute respiratory distress syndrome?[J]. Curr Opin Crit Care, 2003, 9(1): 15-21.
7. 　于大興, 翁利, 彭勁民, 等. 生理指標對容量負荷試驗結果的預測價值[J].中華醫學雜志, 2010, 90(41): 2935-2938.
8. 　Fernandes CJ, Akamine N, Knobel E. Myocardial depression in sepsis[J]. Shock, 2008, 30(Suppl 1): 14-17.
9. 　Alsous F, Khamiees M, DeGirolamo A, et al. Negative fluid balance predicts survival in patients with septic shock: a retrospective pilot study[J]. Chest, 2000, 117(6): 1749-1754.
10. 　于大興, 翁利, 彭勁民, 等. 血管外肺水對危重病患者預后的預測價值[J]. 中華內科雜志, 2011, 50(3): 251-253.
11. 　李曉君. 床旁超聲對氣胸的診斷價值[J].中國醫療設備, 2009, 24(7): 95-96.
12. 　張茂, 干建新, 游向東, 等. 床旁胸部超聲在危重患者中應用的進展[J]. 中國急救醫學, 2006, 26(3): 213-215.
13. 　Vignon P, Chastagner C, Berkane V, et al. Quantitative assessment of pleural effusion in critically ill patients by means of ultrasonography[J]. Crit Care Med, 2005, 33(8): 1757-1763.
14. 　王小亭，劉大為. 重視心臟多普勒超聲在重癥醫學領域中的應用[J].中華內科雜志, 2011, 50(7): 539-540.

West China Medical Journal

The Value of Bedside Ultrasound in Improving Treatment in ICU

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