急诊床旁超声在腹部脏器闭合性损伤诊断中的应用价值

目的 探讨急诊床旁超声检查对腹部闭合性损伤的诊断应用价值.方法 应用便携式超声仪对184例外伤患者行急诊床旁超声检查,观察腹部脏器声像图有无异常改变,并重视观察腹腔内有无游离液体及气体.结果 超声诊断总符合率91.8%(169/184),其中单脏器损伤156例,符合率95.5%(149/156),多脏器损伤28例,符合率71.4%(20/28),漏诊21例,误诊3例,漏、误诊率13%(24/184).手术治疗119例;保守治疗65例,经CT、MRI检查及临床保守治疗证实.结论 急诊床旁超声检查对腹部闭合性损伤的诊断符合率高,为临床提供迅速、可靠的诊断信息.     

急诊床旁超声在腹部脏器闭合性损伤诊断中的应用价值

目的 探讨急诊床旁超声检查对腹部闭合性损伤的诊断应用价值.方法 应用便携式超声仪对184例外伤患者行急诊床旁超声检查,观察腹部脏器声像图有无异常改变,并重视观察腹腔内有无游离液体及气体.结果 超声诊断总符合率91.8%(169/184),其中单脏器损伤156例,符合率95.5%(149/156),多脏器损伤28例,符合率71.4%(20/28),漏诊21例,误诊3例,漏、误诊率13%(24/184).手术治疗119例;保守治疗65例,经CT、MRI检查及临床保守治疗证实.结论 急诊床旁超声检查对腹部闭合性损伤的诊断符合率高,为临床提供迅速、可靠的诊断信息.     

急诊超声检查在闭合性腹部损伤中的应用

目的 总结２０８例闭合性腹部损伤超声声像表现,探讨超声在急性闭合性腹部损伤诊断中的应用价值。方法 对各种原因所致的腹部脏器损伤进行急诊超声检查,其中１３５例接受手术治疗。结果 与手术结果对照,术前超声诊断总符合率为９１．１％。结论超声检查简便快速,对腹部脏器损伤情况能提供客观而可靠的证据,并为临床确立治疗方案提供依据。     

150例闭合性腹部外伤的超声诊断分析

目的:探讨超声检查对闭合性腹部外伤的诊断价值及漏、误诊原因。材料和方法:150例闭合性腹部损伤患者在受伤后1～12小时内接受超声检查。结果:经临床证实总符合率94.0%(141/150)。脾损伤符合率96.6%(84/87),肝脏损伤符合率90.5%(19/21),肾损伤符合率为93.9%(31/33)。结论:超声检查是诊断闭合性腹部外伤的有效方法之一。     

急诊超声检查腹部创伤245例

目的探讨急诊超声在腹部创伤后定位诊断内脏损伤的价值.方法回顾分析急诊超声诊断并经手术或CT证实的腹部创伤所致内脏损伤245例.结果①245例共346个脏器损伤,超声确诊299例,误诊47例,总符合率为86.4%;②超声诊断脾、肝、肾及胃肠、肠系膜血管、膀胱、后腹膜脏器损伤等符合率分别为：93.4%、91.9%、80.9%及51.3%;③超声与手术比较检出腹腔积液及腹膜后血肿符合率分别为：100%（213/213）和89.5%（51/57）.结论急诊超声对腹部创伤后定位诊断脏器损伤具有较高临床诊断价值.     

腹部闭合性损伤88例临床救治分析

目的总结腹部闭合性损伤的诊断与治疗经验。方法对本院2000年7月—2004年7月收治的88例腹部闭合性脏器损伤的诊断与治疗的临床资料进行回顾分析。结果腹腔穿刺的诊断阳性率92105%(81/88),腹部B超诊断的阳性率92105%(81/88),B超损伤脏器的定位诊断准确率8118%(72/88),腹部CT检查阳性率100%(22/22)。手术治疗78例,非手术治疗10例;治愈83例(9413%),死亡5例(517%)。结论腹腔穿刺,腹部B超及CT检查对腹部闭合损伤的诊断都有重要价值,治疗应以手术治疗为主,如有适应证非手术治疗也可取得满意效果。     

腹部闭合性创伤的急诊CT评价

目的：探讨急诊CT扫描在腹部闭合性创伤中的应用价值。方法：收集整理经手术或临床证实的腹部闭合性创伤65例急诊CT检查的影像资料,进行回顾性分析,所有病例均行CT平扫。结果：腹部闭合性创伤的急诊CT扫描主要表现为混杂高密度影像,多伴腹腔出血。本组65例腹部闭合性创伤中,肝脏损伤15例、脾26例、肾13例,肠系膜与肠管损伤2例,膀胱破裂2例,复合性实质性脏器损伤7例。其中51例伴腹腔出血,22例合并肋骨骨折。结论：急症CT扫描对诊断腹部闭合性创伤具有很大的价值,能明确腹部脏器损伤的部位、程度及复合性脏器损伤等信息,以指导临床医师制定有效的治疗方案。     

腹部脏器闭合性损伤的超声诊断价值

超声检查作为有价值的临床辅助检查手段,被广泛应用于腹部脏器损伤的常规检查。本文通过对我院2000年6月~2006年10月因腹部脏器闭合性损伤住院患者声像图及手术病理对比或住院保守治疗并进行其他影像学检查证实的157例进行回顾性分析。探讨超声检查在腹部脏器闭合性损伤声像图特征。1材料与方法本院2000年6月~2006年10月因腹部脏器闭合性损伤住院手术保守治疗的患者157例,其中男性96例,女61例,年龄7~62岁。肝损伤45例,脾损伤62例,胰腺损伤4例,肾脏损伤13例,肠管及肠系膜损伤12例,腹膜后血肿5例,膀胱破裂4例,多脏器损伤12例。仪器采用Philip…     

急诊床边超声检查在腹部闭合性损伤诊断中应用价值

超声检查具有易操作简单、重复性较强等优点,因而在临床上具有重要的应用价值[1～4].本文收集2009年12月～2011年12月在我院进行治疗并经超声检查的腹部闭合性损伤患者137例临床资料,探讨急诊床边超声检查在腹部闭合性损伤诊断中的应用价值.     

B超与多层螺旋CT诊断急诊腹部创伤临床价值分析

目的探讨B超与CT用于急诊腹部创伤诊断临床价值差异。方法分析我院收治急诊腹部创伤患者132例的B超与CT影像学检查资料,比较两种影像学方式脏器损伤及损伤程度分级诊断临床符合率。结果 B超和CT用于急诊腹部创伤患者脏器损伤及损伤程度诊断临床符合率比较差异无统计学意义(P0.05)。结论 B超与CT检查急诊腹部创伤诊断诊断均具有较高临床应用价值,其中B超因价格低廉、无辐射及可行床边检查等优势可作为首选诊断方法。     

Prospective evaluation of handheld ultrasound in the diagnosis of blunt abdominal trauma

OBJECTIVES: To evaluate the Sonosite 180 handheld ultrasound in the diagnosis of haemoperitoneum in blunt abdominal trauma. METHODS: Trauma ultrasound using the Focused Assessment with Sonar for Trauma (FAST) technique was performed using the Sonosite 180 handheld ultrasound during the primary survey of adult patients triaged to the resuscitation room with multiple trauma or suspected abdominal injury. The ultrasound findings were compared against the investigation of choice of the attending surgeon/accident & emergency physician--CT, DPL, laparotomy or clinical observation. RESULTS: 50 patients who had sustained blunt abdominal trauma were evaluated using FAST. Satisfactory images were obtained in 96%. There were 5 true positive scans confirmed by CT, DPL or laparotomy. There were no false negative or false investigations. The sensitivity and specificity of handheld FAST was 100%. CONCLUSIONS: Handheld ultrasound using the Sonosite 180 system can be successfully used by appropriately trained doctors as the primary investigation in the acute evaluation of blunt abdominal trauma.     

肾损伤300例临床分析

为探讨肾损伤的诊断与治疗方法，作者对300例肾损伤进行了回顾性分析。其中闭合性损伤274例（91．3％），开放性损伤26例（8．7％）；合并伤123例（41％）；伴失血性休克56例（18．7％）。常规剂量IVU阳性率48．7％，双倍剂量IVU阳性率90．9％，B超阳性率79．3％，CT阳性率95．7％；非手术治愈185例，死亡14例。研究结果表明，B超可作为初步判断肾脏伤情最便捷的检查；CT检查准确快速，能正确显示肾脏伤情；治疗主要取决于伤情，保守治疗是重要的治疗方法；手术经腹 探查切口利于腹腔脏器探查及伤肾处理；早期处理中及时纠正休克、预防严重并发症的发生极为重要。     

闭合性腹部外伤致肠系膜损伤的CT影像价值

目的 探讨肠系膜损伤的CT表现.方法 回顾性分析28例因外伤所致肠系膜损伤患者的CT资料,26例经手术证实,2例保守治疗.结果 CT扫描发现单纯性肠系膜损伤5例,合并其他脏器多发性损伤23例;术前CT诊断为肠系膜损伤仅18例,漏诊率为36%.结论 多层螺旋CT扫描是诊断急性肠系膜损伤的重要方法.     

Screening US for blunt abdominal trauma: objective predictors of false-negative findings and missed injuries

PURPOSE: To determine the risk for missed injury in patients with blunt abdominal trauma and negative findings at screening ultrasonography (US) and with coexistent hematuria or fracture of the sixth through 12th ribs, lumbar spine, or pelvis. MATERIALS AND METHODS: From a database of 4,000 patients screened with US for blunt abdominal trauma at a level 1 trauma center, the 3,679 patients with negative US findings were retrospectively classified by consensus of two authors into high-risk (n = 494) and low-risk (n = 3,185) groups based on the presence of hypothetical predictors of missed injury: hematuria (n = 96) or fracture of the sixth through 12th ribs (n = 216), lumbar spine (n = 105), or pelvis (n = 174). Outcome in each patient was determined by the same two authors consensually after retrospective review of the trauma registry and all radiologic, surgical, and autopsy reports. The risk for missed abdominal injury was determined for each patient risk group and for each hypothetical predictor. Risks were statistically compared by using the Pearson chi2, Fisher exact, or Fisher-Freeman-Halton exact test, depending on expected frequencies. RESULTS: High-risk patients were 24 times more likely to have abdominal injuries after negative US findings (30 [6.1%] of 494) than were low-risk patients (eight [0.25%] of 3,185) (P <.001). Among high-risk patients, the absolute risks for missed abdominal injury associated with specific predictors were 15.6% (15 of 96 patients) for hematuria, 6.0% (13 of 216) for lower rib fractures, 7.6% (eight of 105) for lumbar spine fractures, and 5.2% (nine of 174) for pelvic fractures. Each of these risks was significantly higher for patients in the high-risk group than for those in the low-risk group (P <.001). CONCLUSION: Hematuria and fracture of the lower ribs, lumbar spine, or pelvis are objective predictors of missed abdominal injury in patients with blunt abdominal trauma and negative US findings, and such patients may benefit from additional screening with computed tomography.     

Sonography in a clinical algorithm for early evaluation of 1671 patients with blunt abdominal trauma

OBJECTIVE: The purpose of this study was to evaluate the efficacy of sonography in our algorithm when differentiating patients with blunt abdominal trauma who need immediate surgery from patients who would benefit from further diagnostic workup or who need no treatment. SUBJECTS AND METHODS: We performed abdominal sonography as the primary screening tool in 1671 consecutive patients in our prospective study. Radiologists performed sonography in the trauma room within minutes of the arrival of each patient. Hemodynamic instability in conjunction with positive sonographic findings led to emergency laparotomy. Otherwise, positive sonographic findings warranted additional diagnostic tests. Observing free fluid or organ injury caused us to categorize sonographic findings as positive. RESULTS: Sonography correctly identified all patients requiring emergency laparotomy. No inconclusive laparotomies were performed in this group. The sensitivity of sonography for revealing intraabdominal injury was 88%, the specificity was 100%, and the accuracy was 99%. In 132 patients (8%), abdominal CT was performed. CT revealed relevant posttraumatic abnormalities in 61% of all patients. Four hundred seventy patients with negative sonographic findings were discharged approximately 12 hr after admission; two of these patients (0.4%) were mistakenly discharged. Trauma scores did not influence the efficacy of sonography. CONCLUSION: Our algorithm that uses sonography as the primary diagnostic tool provides accurate, fast, cost-effective, and noninvasive initial management of patients with blunt abdominal trauma. Our test characteristics were excellent indicators of the need for emergency laparotomy. Sonography also achieves high values in revealing relevant injury. Our algorithm produced medically satisfactory and economically prudent management of patients with blunt abdominal trauma.     

Blunt splenic trauma in adults: CT-based classification and correlation with prognosis and treatment

Nonsurgical management of blunt splenic injury in children is a well-established method to salvage splenic function; however, nonsurgical management of adult blunt splenic trauma remains controversial. To assess the value of preoperative abdominal CT in predicting the outcome of blunt splenic injury in adults, a CT-based injury-severity score consisting of four grades was devised and applied in 39 adult patients with blunt splenic injury as the sole or predominant intraperitoneal injury detected with preoperative CT. While patients with high grades of splenic injury generally required early surgery, eight (35%) of 23 patients with initial grade 3 or 4 injury were treated successfully without surgery, and four (29%) of 15 patients with grade 1 or 2 injury initially treated nonsurgically required delayed celiotomy (n = 3) or emergency rehospitalization. Results show that while CT remains an accurate method of identifying and quantifying initial splenic injury, as well as documenting progression or healing of critical injury, CT cannot reliably help predict the outcome of blunt splenic injury in adults. Treatment choices should therefore be based on the hemodynamic status of the patient and results of serial laboratory and bedside assessments.