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An Approach to Point-Of-Care Ultrasound Evaluation of the Abdominal Aorta
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この患者は急性胸部大動脈解剖を患っていますか?
1Department of Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA. mklompas@partners.org
JAMA
|May 1, 2002
まとめ
急性胸部大動脈解剖の診断は難しい. 突発的な激しい痛みや,脈拍の欠陥のような特定の身体検査の結果が疑惑を高める一方で,それらは常に存在せず,臨床診断を困難にします.
科学分野:
- 心臓病学 心臓病学
- 放射線学 放射線学
- 緊急医療 緊急医療
背景:
- 急性胸大動脈解剖は,診断上の課題を伴う,生命を脅かす状態です.
- 大動脈解剖の遅れた診断は,罹病率と死亡率の増加につながる.
研究 の 目的:
- 急性胸部大動脈解剖のための臨床病歴,身体検査,胸部X線写真の診断の正確さを評価するために.
- 胸前大動脈解剖の診断に役立つ重要な臨床指標を特定する.
主な方法:
- MEDLINEを用いて,1966年から2000年までの英語研究に関する包括的な文献レビューが行われました.
- 該当する研究は,胸部大動脈解剖が確認された連続した患者の臨床結果に焦点を当てた研究でした.
- 既定の品質および含有基準に基づいて21件の関連する研究が選択されました.
主要な成果:
- 突然の激しい痛み (90%の感度) と突然の発症 (84%の感度) は,胸前大動脈解剖において一般的です.
- パルス欠陥 (LR 5.7) や神経学的欠陥 (LR 6.6-33.0) のような物理的な発見は,疑いを大幅に高めます.
- 正常な胸部放射線写真 (負のLR 0.3) または突然の痛みの欠如は,解剖の可能性を低下させます.
結論:
- 脈の欠陥,神経学的欠陥,突然の激しい痛みは,急性胸部大動脈解剖の重要な指標です.
- 正常な胸部X線写真や突然の痛みの欠如は,解剖の可能性を減らすことができます.
- 臨床検査だけでは,感度が低く,誤診のリスクが高いため,大動脈解剖を排除するには不十分です.
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