超声诊断外伤性腹腔脏器破裂体会

本文回顾性分析我院2004年1月至2006年12月超声诊断急诊外伤性腹腔脏器破裂患者168例的临床资料,现总结报道如下。1资料与方法1.1一般资料我院急诊进行超声检查后再行手术的患者168例,男112例,女56例,年龄8~72岁,临床均有不同程度的腹痛及压痛。失血性休克69例(41%),明显腹膜刺     

外伤性腹腔脏器破裂的超声特征及临床价值

目的观察总结外伤性(闭合性)腹腔脏器破裂的声像图特征，为临床提供有价值的诊治依据。方法对97例超声诊断为外伤性内脏破裂患的声像图进行观察、记录，并根据临床诊治结果进行分析。结果97例中经超声诊断腹腔积液的95例，经手术证实94例，准确率96．9％(94／97)；超声诊断有94例实质性脏器(包括肝、脾、肾、胰腺)破裂，后经手术证实的有89例，准确率91．7％(89／97)，3例密切追踪观察治疗后痊愈，2例误诊；97例中3例超声诊断为空腔脏器破裂，手术证实2例，误诊1例。结论无论是空腔脏器破裂还是实质性脏器破裂，及时准确的超声诊断具有重要的意义。     

急诊影像学对外伤性胸腹腔脏器破裂诊断价值的分析

目的：探讨胸腹腔急性创伤后超声、CT、X线平片的诊断价值，提高对胸腹部脏器损伤的诊断能力。方法：对46例急性创伤病的X线平片、超声、CT检查与手术病理资料进行回顾性分析。结果胸腹部X线平片在无肺及胃肠破裂的情况下，影像特征表现不明显。超声对损伤脏器内、包膜下及胸腹腔积血等声像图检诊阳性率较高。CT平扫可显示损伤脏器体积轻-中度增大，其实质内呈条片状及团块状高、低、等密度影相互夹杂，形成“花斑状”改变，且包膜下可见环绕液性密度影。结论：X线平片在辅助诊断中有一定的作用。超声可作为初诊有效手段，有很大的实用性，对损伤分型不够理想。CT对胸腹腔内脏器损伤能提供较高、较准确的诊断，且还能对损伤作出明确分型。     

外伤性腹腔脏器破裂的超声诊断

目的 观察总结外伤性（闭合性）腹腔脏器破裂的声像图特征,为临床提供有价值的诊治依据。方法 总结超声诊断并经手术证实的外伤性内脏破裂106例,并对其超声图像进行综合分析。结果 超声对内脏破裂出血所致腹、盆腔积液的检出率为100％（106／106）,脏器破裂的定位诊断符合率82．1％（87/106）。结论 无论是空腔脏器破裂还是实质性脏器破裂,超声诊断准确率较高,能为临床提供极有价值的影像学信息,应成为首选的影像学检查方法,但同时提出检查中值得注意的几个问题。     

延迟性腹腔脏器外伤破裂的超声诊断

我院自2002年3月～2004年9月期间，以外伤就诊的324例患在受伤后24h内至一周行腹部超声常规检查，立即诊断的56例阳性患得到及时处理，同时有268例阴性患在24h后复查中，17例出现腹腔脏器延迟性破裂，现报道如下。     

腹腔脏器破裂手术的护理配合

严重创伤引起的肝、脾、肾、胰破裂是常见的急腹症，因来势凶猛，病人常因失血过多，导致失血性休克。急诊手术探查是主要的抢救措施。我院手术室近年来收治外伤引起的腹腔脏器破裂40例，由于医护配合默契，手术效果良好，现将术中护理要点介绍如下。lits床资料1．1本组40例，男性32例，女性8例，年龄10－65岁。人院时血压在4－10．7／2．67－5．33kPa者32例，血压在2．67－4／offe8例；经手术探查诊断为肝破裂8例，脾破裂22例，肾破裂合并后腹膜巨大血肿8例，胰断裂2例；治愈39例，死亡回例。2护理要点2．1术前准备2．1．1护士在测体温、…     

Assessment of measures for abdominal adiposity in persons with spinal cord injury

Ultrasound may be a useful tool to assess abdominal adiposity, but it has not been validated in the spinal cord injury (SCI) population. This study evaluated associations between abdominal ultrasound and other methods to assess adiposity in 24 men with SCI and 20 able-bodied (AB) men. Waist (WC) and hip circumference (HC) and waist-to-hip ratio (WHR) were measured. Trunk (TRK%), android (A%) and waist fat (W%) were determined by dual energy x-ray absorptiometry (DXA); ultrasonography determined abdominal subcutaneous (SF) and visceral fat (VF). The SCI group had greater TRK% (40.0 ± 9.6 vs. 32.0 ± 10.3), W% (47.0 ± 9.7 vs. 40.6 ± 9.4), A% (43.0 ± 9.8 vs. 35.8 ± 10.6) and WHR (0.99 ± 0.1 vs. 0.92 ± 0.06) than the AB group. WC and WHR correlated with VF in the SCI group. These associations suggest that ultrasound may be a useful tool in clinical practice for the measurement of VF in weight loss programs and for the assessment of cardiometabolic disorders.(E-mail: racine.emmons@va.gov)     

严重腹部损伤患者的急救与护理

目的 总结严重腹部损伤患者的急救与护理措施.方法 对58例严重腹部损伤患者进行术前急救护理,术后加强监护及并发症观察及护理.结果 抢救成功55例,成功率94.83%,死亡3例,死亡率5.17%,因肝功能衰竭死亡1例,因出血性休克死亡2例.结论 应重视严重腹部损伤的术前急救,术后加强监测呼吸功能、中心静脉压、血压、尿量及引流液颜色、量的变化.     

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.     

Diagnostic approach to constipation impacts pediatric emergency department disposition

Objectives

Constipation is a common cause of abdominal pain in children presenting to the emergency department (ED). The objectives of this study were to determine the diagnostic evaluation undertaken for constipation and to assess the association of the evaluation with final ED disposition.

腹部闭合性损伤合并单纯性小肠破裂的诊治探讨(附31例报告)

目的探讨外伤性闭合性单纯性小肠破裂的早期诊断及治疗方法。方法回顾分析和总结31例外伤性闭合性单纯性小肠破裂患者的临床资料。结果本组31例全部治愈，治愈率100％；术后并发切口感染1例，经局部更换敷料后痊愈。结论掌握单纯性小肠破裂的特点，早期诊断；掌握好探查指征，早期手术，可提高治愈率。     

急诊床旁超声在腹部闭合性损伤诊断中的应用

目的探讨急诊床旁超声检查对腹部闭合性损伤的临床诊断价值,进一步提高床旁超声诊断准确率。方法回顾性分析我院2006年1月至2011年8月经临床确诊的162例腹部闭合性损伤患者的急诊超声检查结果、手术及保守治疗资料。结果 162例患者急诊床旁超声检查与临床最终诊断结果完全符合148例(占91.36%),漏诊14例(仅提示腹、盆腔积液,未确定损伤脏器及部位,占8.64%)。结论急诊床旁超声对实质性脏器损伤的诊断与临床最终诊断结果符合率较高,应作为急性腹部闭合性损伤的首选辅助检查方法。     

Isolated superior mesenteric artery dissection in the emergency department: A rare cause of abdominal pain

Acute onset abdominal pain constitutes a significant proportion of emergency department visits, but only a small fraction of these cases are attributable to vascular pathologies (Bauersfeld, 1947 [1]). In this case, report, we present an incidental diagnosis of Spontaneous Isolated Superior Mesenteric Artery Dissection (SISMAD). A 69-year-old man was admitted to the emergency department complaining of fever, loss of appetite, vague epigastric pain, dysuria, and a productive cough for several days. A lower extremity venous Doppler ultrasound was performed, and a deep venous thrombosis (DVT) was identified in the left main femoral vein and in the proximal segment of the superficial vein. The patient also had no blood flow in the distal part of left external iliac vein. A contrast-enhanced computerized tomography angiography of the thorax and abdomen was performed to detect pulmonary embolism and the etiology of the abdominal pain. No pulmonary embolism was found; however, multiple metastatic nodules were identified in both lungs, as well as infiltration on the posterobasal field of the right lung, metastases on the liver, focal dilatation, and an intimal flap on the middle-distal part of the superior mesenteric artery (SMA) at 2?cm, with a segment that was compatible with isolated dissection. There was a contrast passage on the distal part of SMA, and no sign of bowel ischemia.     

Accuracy of abdominal ultrasound for the diagnosis of small bowel obstruction in the emergency department

BACKGROUND: Emergency physicians frequently encounter patients with acute small bowel obstructions (SBO). Although computed tomography (CT) imaging is the current gold standard in the assessment of patients with suspected SBO in the emergency department, a few studies have examined the use of ultrasound as an alternative imaging technique.METHODS: We evaluated the accuracy of ultrasound performed in the ED by a variety of providers (physicians with various levels of training, physician assistants) compared to CT imaging in 47 patients with suspected SBOs.RESULTS: Our data demonstrated a sensitivity of 93.8% and a specificity of 93.3% when compared to abdominal CT, and a sensitivity of 94.3% and specificity of 95.2% using a composite endpoint of abdominal CT and discharge diagnosis.CONCLUSION: Ultrasound can play an important role in the identification of small bowel obstructions in ED patients.     

急诊床旁超声心动图对心血管系统疾病的诊断价值

目的以ROC曲线法客观分析急诊超声心动图对心血管系统疾病的诊断价值。 方法选取2016年1月至2017年1月绍兴第二医院急诊行床边超声心动图检查的81例心血管疾病患者为研究对象,以后续冠状动脉造影、介入或外科手术等为"金标准",ROC曲线分析急诊超声心动图对心血管疾病的诊断价值,计算各项诊断效能指数,分析超声心动图诊断结果与"金标准"结果间的一致性,比较常规心电图检查与超声心动图诊断结果间的差异性。 结果81例中67例经急诊超声心动图诊断为阳性,14例为阴性,急诊超声心动图诊断结果与"金标准"具有中度一致性（Kappa=0.764,P<0.01）,对各具体疾病类型的诊断准确性比较,差异无统计学意义（P>0.05）。61例经常规心电图诊断为阳性,20例为阴性,诊断结果与"金标准"间一致性较差（Kappa=0.179,P>0.05）。ROC分析显示超声心动图诊断符合率为93.83%,敏感度为94.29%,特异度为90.91%,误诊率为9.09%,漏诊率为5.71%;诊断AUC为0.926。常规心电图诊断符合率为74.07%,敏感度为78.57%,特异度为45.45%,误诊率为54.55%,漏诊率为21.43%;诊断AUC为0.620,诊断效能低于超声心动图。超声心动图与常规心电图的检查反应时间、检查时间、诊断时间比较,差异均无统计学意义（P>0.05）。 结论急诊超声心动图对心血管系统疾病具有较高的诊断价值,并且具有易于操作、检查诊断快捷以及准确性高的明显优势,在急诊心血管疾病的临床诊断中具有推广意义。