不同临床情况患者床旁心脏超声检查的必要性及其对诊治的影响

  目的  探讨不同临床情况患者申请床旁心脏超声检查的必要性及其对患者诊断和治疗的影响。  方法  连续入组2013年7月1日至30日北京协和医院申请并完成床旁心脏超声检查的所有患者, 分析其临床情况, 评价床旁超声检查申请的必要性, 并比较不同临床情况患者完成心脏超声检查后对诊治的影响。  结果  共入组患者58例(男性33例, 56.9%), 平均年龄(56.4±19.9)岁。急诊科申请37例(63.8%), 各重症监护室16例(27.6%), 其他科室5例(8.6%)。床旁超声的申请目的中, 符合美国心脏超声学会和急诊医师学会共识建议的36例(62.1%)。完成床旁心脏超声检查后达到申请目的者53例(91.4%), 根据结果明确了诊断或者对原有诊断作出修正的患者13例(22.4%), 对原有诊断更有信心患者40例(69.0%), 对诊断没有帮助者5例(8.6%); 床旁心脏超声检查后, 需根据心脏情况调整原有治疗方案者16例(27.6%)。完成检查后, 经心内科医生判断确实需要进行床旁超声检查者23例(39.7%), 不需要进行床旁超声检查者35例(60.3%)。符合共识建议的申请, 获得对于诊断有价值信息的可能性显著高于其他申请(P=0.01), 且倾向于更能影响患者的治疗方案(P=0.06);申请符合共识建议检查的必要性显著高于其他申请(P < 0.01)。  结论  目前床旁心脏超声申请需更为严格把握指征; 严格按照相关共识的建议申请床旁心脏超声, 更有可能获得对诊断和治疗有价值的信息, 从而更为合理有效地利用有限的医疗资源。

Necessity of Bedside Echocardiography for Patient with Different Clinical Conditions and Its Values in Diagnosis and Treatment

Objective To evaluate the necessity of bedside echocardiography （ ECG） in patients with different clinical conditions and to investigate its values in diagnosis and treatment .Methods We analyzed the clinical conditions of all the patients who applied for and received bedside ECG in Peking Union Medical College Hospital from July 1 to 30, 2013.The necessity of this examination and its values in the diagnosis and treatment were evaluated.Results Fifty-eight patients were included （33 males, 56.9%）, aged （56.4 ±19.9 ） years. Thirty-seven （63.8%） patients were from emergency department , 16 （27.6%） were from intensive care units , and 5 （8.6%） from other departments.In 36 （62.1%） patients, the purpose of applications for bedside ECG was in compliance with the consensus of the American Society of Echocardiography （ ASE） and American College of Emergency Physicians （ACEP）.The purposes of bedside ECG were accomplished in 53 （91.4%） applications.The bedside ECG confirmed or altered the initial diagnosis in 13 （22.4%） cases, supported the initial＆amp;nbsp;diagnosis in 40 （69.0%）, but offered no diagnostic information in 5 （8.6%）.Based on the ECG results, the treatment was adjusted in 16 patients （27.6%）.After the examination, 23 （39.7%） applications for bedside ECG were considered necessary by cardiologists , the other 35 （ 60.3%） were unnecessary .Compared with the applications not conforming to the consensus of ASE and ACEP , those conforming to the consensus were significantly more likely to provide valuable diagnostic information （ P =0.01 ） , to result in treatment adjustment （ P=0.06 ） , and to be necessary （ P〈0.01 ） .Conclusions The indications of bedside ECG should be strictly observed .To make full use of the limited medical resources , bedside ECG should be applied in accordance with the consensus of ASE and ACEP to ensure its values in diagnosis and treatment .