掌上超声诊断仪对胸闷、胸痛急诊患者的针对性检查

doi:10.3877/cma.j.issn.1672-6448.2016.06.014

目的

评价掌上超声诊断仪对急诊胸痛、胸闷患者进行超声心动图检查、快捷诊断和初筛的临床价值。

方法

选择2014年1至10月中国医学科学院阜外医院收治的271例急诊患者。应用美国GE Vscan型掌上超声诊断仪进行床旁超声心动图检查，主要评估心腔内径、左心室收缩功能、节段性室壁运动异常，心包以及升主动脉等。所有患者均在应用美国GE Vscan型掌上超声诊断仪检查之后，再应用美国GE Vivid i型超声心动图检查仪进行检查。采用χ²检验比较Vscan型掌上超声诊断仪与Vivid i型超声心动图检查仪检查结果差异；采用独立样本t检验比较Vscan型掌上超声诊断仪与Vivid i型超声心动图检查仪、高年资医师与低年资医师检查用时差异。

结果

掌上超声诊断仪能对全部271例患者进行清晰成像。经Vscan型掌上超声诊断仪扫查确诊，存在节段性室壁运动异常者91例，左心室收缩功能减低者37例，心包积液3例，升主动脉夹层14例；其余患者超声心动图检查结果未提示存在室壁运动异常或收缩功能异常。Vscan型掌上超声诊断仪在评价节段性室壁运动异常及左心室收缩功能异常各漏诊1例，但Vscan型掌上超声诊断仪与Vivid i型超声心动图检查仪检查结果差异无统计学意义（χ²=0.03，P>0.05）。每个患者的检查时间为1~5 min，Vscan型掌上超声诊断仪与Vivid i型超声心动图检查仪检查用时差异也无统计学意义（t=-1.478，P>0.05）。应用Vscan型掌上超声诊断仪检查时，高年资医师比低年资医师检查用时短，且差异有统计学意义[（2.6±1.4）min vs （3.5±1.8）min，t=-2.41，P<0.05]。

结论

对于以胸闷、胸痛等为主诉就诊的急诊患者，其临床诊断不明确且体格检查等结果为阴性时，掌上超声诊断仪能够有针对性的快速、准确评价心脏解剖结构、功能以及血流动力学状态，从而指导有效治疗，避免漏诊，具有重要的临床应用价值。

关键词: 超声心动描记术, 胸闷, 胸痛

Objective

To study the clinical usefulness of pocket size echocardiography for a cardiac focused ultrasonography in evaluating patients complaining chest pain or dyspnea in Emergency Department.

Methods

Two hundred and seventy-one patients in Emergency Department of Fuwai Hospital were enrolled into this study from January to October in 2014. Patients underwent transthoratic echocardiography with a protocol focusing on the cardiac chamber diameters, left ventricular systolic function, regional wall motion abnormalities, pericardium and ascending aorta using GE Vscan and reconfirmed by GE Vivid i immediately. The results from difference diagnostic tools were compared with Chi Square test. Independent t test was applied to compare the consuming time differences from GE Vscan and GE Vivid i, from junior and senior echocardiographers respectively.

Results

It was possible to obtain good-quality images using pocket size echocardiography device in all patients. Regional wall motion abnormalities were found in 91 patients; left ventricular systolic dysfunction was discovered in 37 patients; 3 patients were with pericardial effusion; and 14 patients were found with ascending aorta dissection. Neither left ventricular systolic dysfunction nor regional wall motion abnormalities were found in the remaining individuals. One case of regional wall motion abnormalities and a case of left ventricular systolic dysfunction were missed by GE Vscan. However, no significant difference was observed between Vscan and Vivid i (χ²=0.03, P>0.05). The scanning time for each patient was 1-5 minutes and there was no significant time difference between Vscan and Vivid i (t=-1.478, P>0.05). Senior echocardiographers took less time for exams than junior doctors [(2.6±1.4) min vs (3.5±1.8) min, t=-2.41, P<0.05].

Conclusions

The pocket size ultrasound equipment was able to obtain reliable information of important cardiovascular structures, function and hemodynamics from patients complaining chest pain or dyspnea. Focused echocardiography for these undiagnosed patients admitted to Emergency Department allows a quick and accurate diagnosis, avoiding missed diagnosis, may have the potential to improve in-hospital diagnostic procedures.

Key words: Echocardiography, Chest dyspnea, Chest pain

图1~6 患者超声心动图常规检查切面。图1　为胸骨旁长轴切面；图2　为大动脉短轴切面；图3　为二尖瓣水平左心室短轴切面；图4　为心尖四腔切面；图5　为心尖二腔切面；图6　为心尖长轴切面

表1 Vscan型掌上超声诊断仪与Vivid i型超声心动图检查仪检查结果比较

方法	例数	超声心动图检查结果（例）					检查用时（min，±s）
方法	例数	节段性室壁运动异常	心包积液	左心室收缩功能减低	主动脉夹层	未见异常	检查用时（min，±s）
Vscan	271	91	3	37	14	126	3.0±1.2
Vivid i	271	92	3	38	14	124	3.0±1.3
检验值	?	χ²=0.03					t=-1.478
P值	?	>0.05					>0.05

表1 Vscan型掌上超声诊断仪与Vivid i型超声心动图检查仪检查结果比较

方法	例数	超声心动图检查结果（例）					检查用时（min，±s）
方法	例数	节段性室壁运动异常	心包积液	左心室收缩功能减低	主动脉夹层	未见异常	检查用时（min，±s）
Vscan	271	91	3	37	14	126	3.0±1.2
Vivid i	271	92	3	38	14	124	3.0±1.3
检验值	?	χ²=0.03					t=-1.478
P值	?	>0.05					>0.05

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Focused echocardiography on patients with chest pain or dyspnea using a pocket size device in Emergency Department

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Focused echocardiography on patients with chest pain or dyspnea using a pocket size device in Emergency Department