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緊急治療室にいるこの呼吸不全患者さんは,心不全を患っているのでしょうか
Charlie S Wang1, J Mark FitzGerald, Michael Schulzer
1Department of Medicine, University of British Columbia, Canada.
JAMA
|October 20, 2005
まとめ
緊急治療室での心不全の診断は,患者の病歴,症状,診断検査の組み合わせに依存しています. 低血清B型ナトリウレチンペプチド (BNP) レベルは,心不全を排除するのに非常に効果的です.
科学分野:
- 緊急医療 緊急医療
- 心臓病学 心臓病学
- 診断の精度 診断の精度
背景:
- 喘息不全は,迅速な診断を必要とする緊急診療所の苦情です.
- 心不全を他の呼吸不全の原因と区別することは,臨床的に重要である.
研究 の 目的:
- 呼吸不全の緊急治療室の患者の心不全に対する臨床発見と日常検査の診断的有用性を評価する.
- 心不全を呼吸困難の他の原因から区別する重要な特徴を特定する.
主な方法:
- 1966年から2005年の間に発表された22の研究を体系的にレビューした.
- データ抽象には,さまざまな診断特性の感度,特異性,および確率比 (LRs) が含まれていました.
- データと品質を評価するために,2人の著者による独立したレビュー.
主要な成果:
- 心不全の主要な指標には,心不全の病歴 (陽性LR=5.8),性急性夜間呼吸不全 (陽性LR=2.6),S3ギャロップ (陽性LR=11),胸部X線写真の肺静脈閉塞 (陽性LR=12.0),心電図の心房細動 (陽性LR=3.8) が含まれる.
- これらの発見がないと,心不全の確率は低下する.
- 低血清B型ナトリウレチンペプチド (BNP) レベル (<100pg/mL) は,心不全を除外するための最も効果的なテストでした (負のLR=0.11).
結論:
- 呼吸不全の患者には,指向された病歴,身体検査,胸部X線写真,心電図を含む包括的なアプローチが推奨されます.
- 血清BNP検査は,特に臨床的な疑念が残っている場合,心不全を排除するために貴重なものです.
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