[重症监护病房经胸超声心动图集中检查的可行性]。

Li-na Zhang, Y. Ai, Zhi-yong Liu, Chunmei Tian, Ji-xiang Zhu
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引用次数: 6

摘要

目的探讨经胸超声心动图(TTE)在重症监护病房(ICU)的临床应用价值及其对临床管理的影响。方法经过12小时的指导和初步的心脏临床评估,强化医师对88例患者进行了集中的TTE(2-4个2D视图,无多普勒或M模式)检查,以评估左心室功能和左心室容量状况,排除局部心室壁运动异常和明显的心包积液。每次检查立即通过超声心动图检查,以确定超声心动图的技术质量和强化医师解释的准确性。结果强化医师在86例(97.7%)患者中成功执行了以诊断为重点的TTE,在75例(85.2%)患者中正确解释了TTE。22.7%的患者根据集中的TTE直接改变了包括液体治疗、肌力药物和血管活性药物在内的治疗方法,45.5%的患者获得了有价值的信息,31.8%的患者没有获得有价值的信息。强化诊断员获得病灶TTE的平均时间为(11.2±5.2)min。结论经过简短的超声心动图系统标准训练后,重症监护医师能够成功实施并正确解读危重患者的重点超声心动图。我们的研究表明,有针对性的TTE可以提供新的信息,这可以改变大量患者的管理。本研究支持在中国将床边目标导向、重点突出的TTE纳入重症监护医师的培训计划。
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[Feasibility of focused transthoracic echocardiography in intensive care unit performed by intensivists].
OBJECTIVE To assess the clinical applicability of focused transthoracic echocardiography (TTE) in intensive care unit (ICU) performed by intensivists and its impacts on clinical managements. METHODS After 12-hour tutorials and initial cardiac clinical assessments, intensivists performed a focused TTE (2-4 views of 2D, without Doppler or M mode) examination in 88 patients to assess left ventricular function and left ventricular volume status, and rule out local ventricular wall motion abnormalities and significant pericardial effusions. Each investigation was immediately reviewed by an echocardiograph to determine the technical quality of the TTE and the accuracy of the intensivist's interpretation. RESULTS Intensivists successfully performed a diagnostic focused TTE in 86 patients (97.7%) and interpreted correctly in 75 patients (85.2%). Management including fluid treatment, inotropic agent and vasoactive agent in 22.7% of patients were changed directly based on the focused TTE, 45.5% of patients were provided with valuable information, while 31.8% of them with non-valuable information. The mean focused TTE acquisition time of the intensivist was (11.2±5.2) minutes. CONCLUSIONS After a brief standard training in using echocardiographic system, intensivists can successfully performed and correctly interpreted a focused TTE for critically ill patients. Our study demonstrates that new information can be provided by focused TTE, which can alter management in a significant number of patients. The present study supports incorporating bedside goal-directed, focused TTE into intensivists' training programs in China.
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