急诊床旁应用超声FAST方案快速评估多发伤的初步研究

目的 研究急诊床旁应用超声FAST方案快速评估多发伤的临床价值.方法 2008年6月至2009年10月,浙江大学医学院附属第二医院急诊科收治的严重多发伤患者,共97例.男性72例,女性25例.年龄14～88岁,(41±16)岁.损伤严重度评分(ISS)14～38分,(23.2±9.3)分.纳入标准:①年龄≥14岁;②受伤12 h内;③直接进入急诊复苏室.排除标准:①2 d内死亡且未行腹部CT扫描或剖腹探查;②经FAST评估后直接手术治疗而未行常规超声检查.对研究对象的不同评估方法进行前瞻性对照研究.所有病例均由急诊医生应用超声FAST方案进行腹腔及心包评估,部位包括剑突下四腔心切面、右隔下及肝肾间隙、右结肠旁沟、左隔下及脾肾间隙、左结肠旁沟、盆腔,根据有无游离液体判断腹腔及心包是否有损伤.同时与常规超声检查、CT扫描及手术结果进行比较.FAST与常规超声耗时比较用配对资料t检验,两者检查结果一致性用配对McNemar检验,计算FAST与常规超声的特异度、敏感性、阳性预测值、阴性预测值、假阳性率、假阴性率、准确率.两者率的比较用Fisher检验.结果 FAST耗时1～6min,(3.18±0.79)min,显著短于常规超声检查(16.63±4.62)min,(t=28.61,P＜0.01).97例患者中,FAST阳性者11例,阴性者86例,其中4例为假阴性.与常规超声结果比较差异无统计学意义(P=0.5).从诊断效能看,以CT及手术结果作为金标准,FASST的敏感性为73%,特异性为100%,阳性预测值100%,假阳性率为0,阴性预测值为95.3%,假阴性率为4.6%,总准确率为95.9%,与常规超声相比,差异无统计学意义.结论 只要经过适当培训,急诊科医生完全可以掌握FAST技术,对严重创伤患者腹部损伤及心包作出快速准确的判断.

Study on the value of focused abdominal sonography for trauma used by emergency doctor in emergency department

Objective To study the value of focused abdominal sonography for trauma (FAST) used by emergency doctor in emergency department. Method It's a prospective,double-blinded and controlled study from June 2008 to October 2009. A total of 97 casualties with severe multiple trauma, 72 male and 25 female aged from 14 to 88 years old with average age of (41 ± 16) ,admitted to emergency department were enrolled, and the bedside focused abdominal sonography for trauma was performed by emergency doctor. It was diagnosed as positive if free fluid was detected in abdomen or pericardium. The severe injury scores (ISS) were from 14 to 38 with average score of (23.2±9.3). The criteria of inclusion were age over 14 years old, injury happened within 12 hours and casualties admitted directly into emergency room. The criteria of exclusion were death of patients within 2 days without CT scanning of abdomen and exploration of abdomen with laporotomy, and operations directly determined by using FAST without conventinal sonographic examination. The FAST was compared with CT and conventional sonography judged by the findings observed during operation. Results The examination with FAST was completed in (3.18±0.79) min, whereas that with conventional sonography was (16.63t4.62) min(t = 28.61,P ＜0.001). The FAST was positive in 11 cases and negative in 86 cases, whereas the conventional sonography was positive in 13 cases and negative in 84 cases ( P = 0.5). There were 4 false negative findings in FAST resulting in 73% sensitivity, 100% specificity, 95.3% negative predictive value, 4.6% false negative rate, 100% positive predictive value, 0% false positive rate and 95.9% accuracy. Conclusions The emergency doctors are able to operate the FAST well for casualties with multiple trauma in emergency department after proper training.