肺部超声在危急重症中的应用进展

目前临床上对肺部疾病的诊断主要依赖于胸部X线和CT检查,但危急重症患者搬运到CT室存在高风险,且X线和CT不能实时动态监测疾病的发展变化。随着超声诊断技术的发展,肺部这一超声“禁区”被逐渐打破,并被运用于临床诊疗中。本文对肺部超声在危急重症中的应用进展作一综述。     

肺部超声在婴幼儿不同肺部疾病中的应用进展

呼吸系统疾病的传统影像学检查方法主要为X线和CT,但均有一定辐射,在儿童中应用受限。随着近年来超声技术的不断提高,肺部超声在肺部相关疾病的早期诊断、病情评估及预后监测等方面均发挥了重要作用。本文就肺部超声在婴幼儿不同肺部疾病中的应用进展进行综述。     

肺部超声在呼吸机相关性肺炎中的临床应用

肺部超声(lung ultrasound,LUS)是诊断社区获得性肺炎的有力工具,但是其在呼吸机相关性肺炎中的诊断作用目前尚缺乏有力证据,本研究就目前已有的研究资料进行分析探讨肺部超声在呼吸机相关性肺炎中的临床应用价值。     

观察肺部超声在心脏急危重症中的应用

目的:观察肺部超声在心脏急危重症中的应用效果与价值。方法:选取本院在2018 年1月—2019年12月期间内收治的心脏危急重症患者50例,同时对患者进行常规胸部超声检查与肺部超声检查,将常规胸部超声检查结果作为对照组,将常规胸部超声检查+肺部超声检查综合结果作为实验组,分析对比两组数据对心脏重症判断的结果。结果:实验组联合判断的检查方式实施之后,得出实验组对于心脏危急重症类型的诊断准确率数据优于对照组,差异具有统计学意义(P<0.05)。结论:肺部超声诊断用于心脏危急重症的检查当中时候,能够有效的避免为重症类型提供特异性判断标准,具有较高的使用价值。     

月市部超声在ICU的应用

对于危重症患者来说,呼吸功能的评价至关重要。一般临床医生通过体格检查配合x线胸片及CT等放射学检查即可对患者肺部情况得出大致印象。通常X线胸片敏感性较低,往往需进一步CT检查,而CT又因为其辐照度高使得检查重复性较差。降低辐照度是现代影像医学的发展方向之一。     

肺部超声评分在儿科疾病中应用与进展

超声对肺内病变的诊断及鉴别诊断价值正在逐渐受到临床重视,肺部超声替代儿科胸部X线片是一种安全可行的方案。近年来,国内外儿科疾病肺部超声评分研究正在逐步开展,本文总结儿童肺部超声评分相关常见影像学特点,就其在儿科肺部疾病中的应用及其进展进行综述,旨在促进超声在儿科肺部超声评分领域中的进步。     

肺超声在分析早产儿早期肺部疾病状态中的应用价值

目的 探讨肺超声(Lung ultrasound, LUS)在分析早产儿出生早期肺部疾病状态中的应用价值。方法 收集我院2018年5月-2019年4月行肺超声检查符合入组条件的低体重早产儿59 例。按照指南推荐,将肺部分为12区,于患儿出生72小时内,应用超声高频探头对早产儿肺部各区进行逐一扫查并进行超声肺部通气评分,以观察患儿肺部超声表现特点,评估患儿肺部疾病状态,并判断评估超声改变与出生胎龄、体重的相关关系。结果 1.不同区域超声肺部通气评分比较：左、右肺部和上、下肺部评分差异无统计学意义（p＞0.05）;后肺部超声肺部通气评分较前肺部增高,差异具有统计学意义（p＜0.05）。2.超声肺部通气评分与出生胎龄及体重关联性分析：超声肺部通气评分总分与出生胎龄具有显著相关关系（r=-0.62,p＜0.01）,与出生体重具有相关性（r=-0.33,p=0.011）。结论 肺超声可早期快速准确地评估低体重早产儿肺部疾病状态,指导临床早期干预治疗。出生胎龄及体重是预示早产儿肺部疾病严重程度的重要因素。     

肺部超声对重症监护病房中新型冠状病毒肺炎的应用价值

目的观察肺部超声在重症监护病房（ICU）接受治疗的新型冠状病毒肺炎（COVID-19）患者中的应用价值。 方法回顾分析2020年2月20日至3月19日武汉雷神山医院B2病区ICU收治的50例COVID-19患者的临床资料。患者在入ICU时均接受肺部CT及肺部超声检查,记录相关数据：APACHE Ⅱ评分、C反应蛋白、白介素6、静态肺顺应性、氧合指数、肺部超声评分,并将CT与超声图像进行对比。记录患者入ICU后28 d内存活情况及存活患者的ICU住院天数。 结果患者的肺部超声评分与APACHEⅡ评分、C反应蛋白、白介素6呈正相关,与静态肺顺应性、氧合指数呈负相关（P均<0.01）;以肺部CT图像为金标准,肺部超声诊断肺部疾病的准确性为90.3%（542/600）、敏感度为87.1%（316/363）、特异度为95.3%（226/237）;入ICU 28 d存活患者的肺部超声评分与ICU治疗时间呈正相关（P<0.01）。 结论肺部超声应用在ICU治疗的COVID-19患者中,与肺部CT一致性高,能有效评估患者的严重程度、炎症状态、肺部顺应性及预测患者预后,可作为在ICU治疗的COVID-19患者的必要监测方法。     

肺部超声评估气胸的临床研究进展

<正>气胸是造成急性呼吸困难的最常见原因之一,临床上以突发一侧胸痛、胸闷气促,甚至呼吸衰竭为主要特征,由于胸膜腔内压力突然改变,导致静脉回心血流受阻,影响心肺循环的稳定性,急需早期诊断与处理。根据发病原因的不同,气胸可以分为两大类:创伤性气胸和自发性气胸,前者包括医源性气胸,后者可进一步分为原发性和继发性气胸。其中自发性气胸在男性中的发病率为24/100 000,虽然死亡率低,但复发率高达35%[1],已受到越来越多研究者的关注。尽管胸部计算     

基于肺部超声的气道廓清方案在ICU机械通气患者中的应用

目的 探讨基于肺部超声的气道廓清方案在ICU机械通气患者中的应用效果。方法 采用目的抽样法,选取2021年1月—2022年6月入住合肥市某三级甲等综合医院ICU的机械通气患者,根据随机数字表法分为试验组和对照组。试验组实施基于肺部超声的气道廓清方案,对照组实施常规的气道廓清方案。比较干预第1、3、5天,两组肺部超声评分、氧合指数、膈肌功能情况及机械通气时间的差异。结果 共纳入研究对象123例,其中17例因自动退出或在ICU入住未满5 d给予剔除,最终纳入106例,试验组56例,对照组50例。重复测量方差分析结果显示,两组肺部超声评分、氧合指数、膈肌运动幅度及膈肌厚度变异率的时间与组间存在交互效应（P<0.05）。两组机械通气时间比较,差异无统计学意义（P=0.902）。结论 基于肺部超声的气道廓清方案有助于改善患者氧合状况,增强膈肌功能。     

Role of renal sonography in the intensive care unit

PURPOSE: This study was conducted to evaluate the role of portable renal sonography in the intensive care unit (ICU). METHODS: We conducted a retrospective study of 402 ICU patients who underwent renal sonography. We recorded demographic data, underlying disease, type of ICU, renal function test results, etiology of renal failure, need for dialysis, and outcome for patients with acute renal failure (ARF). The indications for and results of sonography were analyzed. RESULTS: The most common indication for a renal sonographic examination was ARF (320/402, 79.6%). Hydronephrosis was found in 5 patients with ARF. Chronic renal failure was confirmed by sonography in 40% of the patients with an indeterminate cause of renal failure. In 33% of cases of complicated urinary tract infections, sonography revealed abnormalities. Renal sonography was also useful for follow-up assessment of patients treated with percutaneous nephrostomy and patients with a history of renal tumor, hydronephrosis, adrenal tumor, hematuria of unknown cause, or fever of unknown origin. CONCLUSIONS: Since renal disease is common in the ICU, renal sonography is a convenient and useful diagnostic tool in this setting.     

The impact of a physician-staffed mobile intensive care unit

In the United States, mobile intensive care units (MICU) staffed by paramedical personnel are the means by which virtually all patients are transported to hospitals. However, in many other countries, MICUs are physician-staffed. The role of physicians in the MICU in delivering emergency pre-hospital care in Israel was examined. In one year's experience on a physician-attended MICU, 1,200 of 3,919 patients (31%) were definitively treated in the pre-hospital phase and not transported to a hospital facility. A careful follow-up of these patients is reported. In 235 cases death was pronounced by the MICU physician, and the patient was not transported. In 965 cases, the problem was diagnosed and the patient treated without a referral for further immediate treatment. Follow-up was obtained for 869 (90%) of these patients, of whom 843 (97%) required no additional emergency attention during the 48-hour follow-up period. The use of a physician-attended MICU reduces the service load on emergency departments.     

Intensive care unit staff nurses: predicting factors for career decisions

Aims and Objectives. The aim of this study was to understand the factors related to intention to leave their job among intensive care unit (ICU) nurses in eastern Taiwan and to make between‐group comparisons between an intention to leave and an intention to stay as well as to predict the influencing factors that affect ICU staff nurses’ intention to leave. Background. Nurses’ intention to leave their job may have an important impact on the actual turnover of nurses. The issue has always been of concern to nursing executives. Only limited empirical studies in the area have been investigated in an Asian culture context and particularly the eastern Taiwan region. Methods. A cross‐sectional predictive study was performed during 2005 with 130 nurses recruited from two ICUs at a medical centre. A researcher‐designed questionnaire based on the Cooper's model with structured interviews was used to determine each nurse's characteristics and their intention to leave their job. Multiple logistic regression analysis was employed to investigate the various factors associated with this. Results. The overall response rate was 100%; 63 (48·9%) revealed that they intended to leave their jobs. The findings were that their self‐rated health status, the number of diseases, the level of happiness, the presence of depression, job satisfaction, sleep quality, type of license and their unit were significantly associated with an intention to leave (p = 0·05–0·001). Depression and sleep quality proved to be the most significant predictors of ICU staff nurses’ intention to leave their job. Conclusions. The findings suggest that there is a need to take steps to improve nurses’ health‐related quality of life and to develop effective strategies to improve nurse retention. Relevance to clinical practice. A succinct validated instrument would help identify the important factors that predict ICU nurses’ intention to leave their job, which may result in job disengagement. Predictors found in this study may be used as outcome variables for developing such an effective method of improving nurse retention in ICUs.     

临床医护工作站在急诊重症监护病房的应用与效果

目的研究临床医护工作站在急诊重症监护室环境下的应用方法与效果。方法首先对病室空间及环境进行改造,在急诊重症监护室患者床旁设立临床医护工作站实施管理。结果设立临床医护工作站后,临时医嘱处理时间缩短,不良事件的发生率下降,患者满意度提升。结论临床医护工作站的设立,能够帮助护理人员快速发现急危重症患者病情变化,及时处理医嘱,发现和防范医护工作隐患,减少护理不良事件的发生。     

Clinical review: impact of emergency department care on intensive care unit costs

Critical care is both expensive and increasing. Emergency department (ED) management of critically ill patients before intensive care unit (ICU) admission is an under-explored area of potential cost saving in the ICU. Although limited, current data suggest that ED care has a significant impact on ICU costs both positive and negative. ICU practices can also affect the ED, with a lack of ICU beds being the primary reason for ED overcrowding and ambulance diversion in the USA. Earlier application in the ED of intensive therapies such as goal-directed therapy and noninvasive ventilation may reduce ICU costs by decreasing length of stay and need for admission. Future critical care policies and health services research should include both the ED and ICU in their analyses.