ICU床旁B超对气胸诊断价值.docVIP

ICU床旁B超对气胸诊断价值 　　[摘要] 目的 探讨在ICU病房中床旁B超对气胸诊治中的临床应用价值。 方法 对我院ICU收治的怀疑气胸患者76例，均进行床旁B超、平卧位胸部X片、胸部CT检查。以胸部CT检查为诊断气胸的金标准。对比床旁B超及胸部X线片对气胸的敏感性、特异性、阳性预测值、阴性预测值、准确度。 结果 B超、X线、CT在诊断上差异无统计学意义，B超与X光在敏感性、特异性、阳性预测值、阴性预测值、准确度上无差异。但是B超在所需时间上与X光及CT差异有统计学意义。 结论 床旁B超与胸部X线片检查在对于诊断气胸无显著差异，但床旁B超具有快捷、方便、实时的特点，所以值得临床推广。 　　[关键词] 床旁B超；气胸；ICU；CT；胸片 　　[中图分类号] R445.1 [文献标识码] B [文章编号] 2095-0616（2016）09-155-04 　　[Abstract] Objective To explore and discuss the clinical application value of bedside B-mode ultrasound in ICU for diagnosing and treating pneumothorax. Methods 76 patients with suspicious pneumothorax in the hospital’s ICU were examined by bedside B-mode ultrasound，supine chest X-ray and thoracic CT.The thoracic CT examination was the gold standard for diagnosing pneumothorax.The sensitivity，specificity，positive predictive value，negative predictive value and accuracy of pneumothorax were compared between bedside B-mode ultrasound and chest X-ray. Results There had no statistical differences among B-mode ultrasound，X-ray and CT in diagnosis，the sensitivity，specificity， positive predictive value，negative positive value and accuracy of B-mode ultrasound and X-ray had no differences.But the time required of B-mode ultrasound and X-ray had statistically significant difference. Conclusion There had no significant differences between bedside B-mode ultrasound and chest X-ray examination for diagnosing pneumothorax，but bedside B-mode ultrasound had the fast，convenient and real-time characteristics，which was further worthy of clinical promotion. 　　[Key words] Bedside B-mod ultrasound；Pneumothorax；ICU；CT；Chest radiograph 　　由于机械通气、中心静脉置管、胸腔穿刺等操作，使ICU重症患者发生气胸的机率增加。但传统的胸部X片由于种种原因，使ICU的医护工作者不能快捷实时地诊断气胸，从而加重患者病情。胸部CT因其无影像重叠的缺点，对气胸的诊断非常容易，常可发现X线阴性的气胸存在[1]。故胸部CT一向被认为是对气胸的诊断价值最高。但是由于CT存在转运的风险，且价格昂贵，故一般不作为诊断气胸的常规方法。过去认为因超声波无法穿透充满气体的肺脏，所以肺部B超检查的一直视为禁区。然而，间质充气、含水量及受损肺泡改变所产生的超声影像及伪影，能间接反映肺部的病理状态，使肺部的B超检查变可能[2]。近年来，国内外学者开始重视B超对肺部的检查价值[3-4]。而且床旁B超对传统X线，具有方便、快捷、实时、费用低且无放射线暴露等特点。本研究对我院2012年6月～2015年9月ICU收治的怀