超声诊断腹部闭合性创伤的价值

1996年8月至2001年5月,我院应用B型超声检查腹部闭合性创伤37例,效果满意,现就声像图表现,临床应用价值报告如下:     

重复扩展创伤重点超声评估技术在急诊ICU的应用价值

目的:探讨重复扩展创伤重点超声评估技术(E-FAST)在急诊ICU创伤患者中的应用价值.方法:采用前瞻性研究方法,选择2019年1月-2020年10月期间收住急诊ICU的外伤患者178例.对患者每日均进行重复E-FAST检查,分别对重复3 d(R3-EFAST)及7 d(R7-EFAST)检查结果进行分析.以临床诊断为...     

B超诊断腹部闭合性创伤的体会

超声检查可以对腹腔内实质性脏器损伤及腹腔内有无积血做出迅速明确的诊断,因而在临床工作中特别在急诊科的工作中得到了广泛应用。本文选择了1995年1月至2003年8月经超声诊断,并由手术病理证实的80例腹部闭合性损伤进行分析。从而评价B型超声对腹部闭合伤的诊断价值。     

创伤重点超声评估法在胸腹部创伤急诊中的应用研究

目的:分析创伤重点超声评估法在胸腹部创伤急诊中的应用。方法:选取2018年4月—2019年10月200例急诊收治胸腹部创伤患者,所有患者均采用常规彩超检查与创伤重点超声评估法检查,并以手术结果为金标准评价两种方法的诊断准确性。结果:两种检查方法在诊断准确率方面的差异无统计学意义,但创伤重点超声评估法检查时间明显短常规彩超检查(P<0.05)。结论:创伤重点超声评估法具有检测速度快且准确率高的优势,在急救检查中能够快速评估患者的病情状况,从而尽早实施有效的救治措施,有助于提高急救效率。     

超声技术的应用在腹部创伤诊断中的价值分析

目的:分析超声技术的应用在腹部创伤诊断中的价值。方法:经我院伦理委员会批准后选取2017年8月—2020年2月收治的55例腹部创伤患者作为研究对象,以上55例患者分别进行超声技术诊断和常规CT诊断,以最终手术探查结果作为金标准,对比两种检查方法的准确率。结果:与最终手术探查结果相对比,超声技术诊断符合率为96.36%,CT诊断符合率为80.00%,超声技术明显优于CT诊断,差异具有统计学意义(P<0.05)。结论:超声技术在腹部创伤诊断中的应用价值较高,能准确探查腹腔积液情况,明确腹部创伤位置,为后期治疗提供依据,对腹部创伤患者具有现实意义,值得临床诊断中推广应用。     

腹部闭合性损伤急诊中的超声诊断价值

目的探讨超声检查在腹部闭合性损伤中的应用价值。方法将我院近11年来急诊收治并经超声检查、临床治疗和手术证实的106例患者资料做回顾性分析。结果超声检查对实质性脏器破裂和腹腔积液的准确性较高。结论超声检查在腹部闭合性损伤的急诊诊断、治疗选择有重要价值。     

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。     

急诊超声在腹部闭合性损伤诊断中的应用价值

目的：探讨急诊超声在腹部闭合性损伤中的应用价值。方法：32例经急诊超声检查均发现腹腔积液考虑有腹部脏器损伤者，均行手术治疗并与超声检查结果对照。结果；急诊超声对腹腔积液的提示率达100％，对腹部脏器损伤的提示率也很高。结论：急诊超声在腹部闭合性损伤诊断中具有重要的应用价值。     

超声在腹部闭合性内脏损伤的诊断价值

目的：探讨超声在腹部闭合性内脏损伤中的诊断价值。方法：我院2005年1月至2006年4月急诊收治并经超声检查，临床治疗和手术证实的42例患者资料进行回顾性分析。结果：超声检查对实质性脏器破裂准确性较高。脾破裂21例、肝破裂10例、肾破裂4例、胰腺破裂1例、肠破裂5例、腹膜后血肿破裂1例。结论：超声对腹部闭合性内脏损伤敏感性高、特异性强，可作早期诊断和首选方法。     

Emergency ultrasound credentialling for focused assessment sonography in trauma and abdominal aortic aneurysm: A practical approach for Australasia

Objective: Focused assessment with sonography for trauma and emergency ultrasound for abdominal aortic aneurysm are now practiced widely by non‐radiologists in emergency departments worldwide. Various credentialling programs have been proposed for novice sonographers; however, their feasibility has been questioned. We adopted the Australasian College for Emergency Medicine (ACEM) credentialling process for emergency ultrasound to determine whether it is feasible for emergency physicians in the Australasian environment. Methods: Three full‐time emergency medicine specialists and a post‐Fellowship Examination trainee at Auckland Hospital undertook the credentialling process. Results: All four participants had sufficient scans to complete the process after 16 months. Accuracy for focused assessment with sonography for trauma, 90% (95% CI 83–95%), and abdominal aortic aneurysm, 99% (95% CI 90–100%), is similar to that previously reported. Conclusion: The ACEM credentialling process for focused assessment with sonography for trauma and abdominal aortic aneurysm is practical and achievable for emergency medicine specialists working in the Emergency Department at Auckland Hospital. Further studies are necessary to determine whether this holds true for other major trauma centres in Australasia.     

The focused abdominal sonography for trauma scan: pearls and pitfalls.

OBJECTIVE: To review the state-of-the-art use of sonography in evaluating the patient with trauma. METHODS: We reviewed our experience in performing more than 5000 sonographic examinations in the patient with trauma. The recent experience of other publications advocating newer applications of sonography in the patient with trauma are discussed and presented in a pictorial fashion. RESULTS: The main focus of sonography in the patient with trauma has been in performance of the focused abdominal sonography for trauma scan. The focused abdominal sonography for trauma scan is usually performed in the patient with blunt abdominal trauma and is used to check for free fluid in the abdomen or pelvis. There are certain pitfalls that need to be avoided and certain limitations of the focused abdominal sonography for trauma scan that need to be recognized. These pitfalls and limitations are reviewed. More recently, sonography has been used to detect certain solid-organ injuries that have a variety of appearances. Thus, sonography may be used to localize the specific site of injury in these patients. More recently, sonography has been used to evaluate thoracic abnormalities in patients with trauma, including pleural effusions, pneumothoraces, and pericardial effusions. CONCLUSIONS: The use of sonography in evaluating the patient with trauma has rapidly expanded in the past decade. Those using sonography in this group of patients should be aware of its many uses but also its potential pitfalls and limitations.     

The utility of focused assessment with sonography for trauma as a triage tool in multiple-casualty incidents during the second Lebanon war.

OBJECTIVE: The purpose of this study was to evaluate the role of focused assessment with sonography for trauma (FAST) as a triage tool in multiple-casualty incidents (MCIs) for a single international conflict. METHODS: The charts of 849 casualties that arrived at our level 1 trauma referral center were reviewed. Casualties were initially triaged according to the Injury Severity Score at the emergency department gate. Two-hundred eighty-one physically injured patients, 215 soldiers (76.5%) and 66 civilians (23.5%), were admitted. Focused assessment with sonography for trauma was performed in 102 casualties suspected to have an abdominal injury. Sixty-eight underwent computed tomography (CT); 12 underwent laparotomy; and 28 were kept under clinical observation alone. We compared FAST results against CT, laparotomy, and clinical observation records. RESULTS: Focused assessment with sonography for trauma results were positive in 17 casualties and negative in 85. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FAST were 75%, 97.6%, 88.2%, 94.1%, and 93.1%, respectively. A strong correlation between FAST and CT results, laparotomy, and clinical observation was obtained (P < .05). CONCLUSIONS: In a setting of a war conflict-related MCI, FAST enabled immediate triage of casualties to laparotomy, CT, or clinical observation. Because of its moderate sensitivity, a negative FAST result with strong clinical suspicion demands further evaluation, especially in an MCI.     

经静脉超声造影在钝性腹部创伤患者中的应用进展

创伤是全球面临的一个重大公共卫生问题，为及时救治创伤患者、降低其死亡率，早期诊断至关重要。然而，在腹部创伤，尤其是钝性腹部创伤患者中普遍存在早期诊断困难。基于微泡造影剂无肾毒性、无辐射、可重复使用等优点，超声造影（contrast-enhanced ultrasound, CEUS）技术在国内外已广泛应用于钝性腹部创伤患者的早期诊断。在血流动力学稳定的患者中，非手术治疗（non-operation management, NOM）是安全有效的，具有减少手术并发症、降低死亡率等优点，已成为目前腹部钝性创伤患者的标准治疗方法，而CEUS在NOM患者病情监测中具有很高的应用价值。本文就近年来CEUS在钝性腹部创伤患者的早期诊断以及在该类接受NOM患者中的监测价值进行综述。     

Screening sonography in pregnant patients with blunt abdominal trauma.

OBJECTIVE: The purpose of this study was to evaluate the accuracy of screening sonography for the detection of clinically significant abdominal injury in pregnant patients with blunt trauma. METHODS: We retrospectively reviewed the records of 5173 patients with blunt abdominal trauma who underwent screening sonography. Pregnant patients were identified, and the prospective sonographic interpretations were compared with surgical findings, computed tomography (CT), subsequent sonography, cystography, and the clinical course. RESULTS: Of 1567 female patients with trauma, 947 were of reproductive age and, 102 (11%) of these 947 were pregnant. One patient was excluded because a truth standard was not available. Five (5%) of these 101 patients were found to have injuries at surgery. These injuries involved the placenta (2 injuries), spleen (2 injuries), liver (1 injury), and kidney (1 injury); all required surgery. Initial sonographic findings were positive in 4 of 5 patients with injuries. The missed injury was a placental injury detected 15 hours after screening sonography because of fetal bradycardia. After screening sonography, 6 patients underwent additional abdominal imaging: CT (3 patients), cystography (1 patient), and additional sonography (2 patients). Of 101 patients, 95 (94%) required no additional tests, and 97 (96%) required no test involving ionizing radiation. No pregnant patient underwent diagnostic peritoneal lavage. Sensitivity was 80% (95% confidence interval, 28%-100%), and specificity was 100% (96 of 96; 95% confidence interval, 96%-100%) for detecting major abdominal injury. CONCLUSIONS: Sonography is an effective screening examination that can obviate more hazardous tests such as CT, cystography, and peritoneal lavage in most pregnant patients with trauma requiring objective evaluation of the abdomen.     

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.     

Prevalence,documentation, and communication of incidental findings in focused assessment with sonography for trauma (FAST) examinations

BackgroundAs the focused assessment with sonography for trauma (FAST) examination becomes increasingly ubiquitous in the emergency department (ED), a parallel increase in incidental findings can also be expected. The purpose of this study was to determine the prevalence, documentation, and communication of incidental findings on emergency physician-performed FAST examinations.MethodsRetrospective review at two academic EDs. Adult trauma patients undergoing FAST examinations used for clinical decision-making at the bedside were identified from an ED ultrasound image archival system. Expert sonologists reviewed ultrasound images for incidental findings, as well as electronic medical records for demographic information, mechanism of injury, type of incidental findings, documentation of incidental findings, and communication of incidental findings to the patient.ResultsA total of 1,452 FAST examinations were reviewed. One hundred and thirty-seven patients with incidental findings were identified (9.4%); 7 patients had an additional incidental finding. Renal cysts were most common (49/144, 34.0%), followed by pelvic cysts in women (32/144, 22.2%). While 31/144 (21.5%) incidental findings were identified and documented in the ultrasound reports or medical records by ED providers, only 6/137 (4.4%) patients were noted to be informed of their incidental findings.ConclusionIncidental findings were often encountered in FAST examinations, with cysts of the kidneys and pelvis being the most common findings. A vast majority of incidental findings were not documented or noted to be communicated to patients, which can be a barrier to follow-up care.     

Nominal free air in the left inguinal fossa due to perforation of the sigmoid colon in a case of blunt abdominal trauma: CT diagnosis

We present a case of perforation of the sigmoid colon due to blunt abdominal trauma. Computed tomography showed nominal free air in the inguinal fossa. The distribution of free air may be a clue to the site of an injured intestine. Early detection of intestinal injury is difficult, but repeated computed tomography after several hours may reveal increased free air.     

Assessment of urinary dipstick in patients admitted to an ED for blunt abdominal trauma

Introduction

Clinicians still face significant challenge in predicting intra-abdominal injuries in patients admitted to an emergency department for blunt abdominal trauma. This study was thus designed to investigate the value of dipstick urinalysis in patients with blunt abdominal trauma.

腹腔镜治疗腹部闭合性外伤临床分析

目的探讨腹腔镜在治疗腹部闭合性外伤中的临床价值。方法回顾性分析25例腹部外伤腹腔镜探查应用的临床资料结果24例在腹腔镜下明确诊断（96．00％）,其中19例腹腔镜下完成手术,5例转开腹完成手术。全组均痊愈出院,无死亡病例。结论在腹部外伤病人中选择适合的病人进行腹腔镜治疗,具有安全可靠、创伤小、恢复快的特点,有助于降低治疗风险．避免部分不必要的开腹手术。