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胸部X射线仍然是一个重要的组成部分之前的管道胸腔切除术
Cody Moore1, Brandon Wilson1, Jeffrey Oury2
1Department of Emergency Medicine, West Virginia University, Morgantown, WV, USA.
The American surgeon
|July 27, 2023
概括
结合床边超声波 (BUS) 和胸部X射线 (CXR) 显著改善了创伤患者中创伤性肺胸部 (PTX) 的识别. 这种结合的方法比单独的成像方式更能表明需要管胸切除术 (TT).
科学领域:
- 紧急医疗 紧急医疗
- 放射学 放射学是一门学科.
- 创伤外科 手术 创伤外科
背景情况:
- 创伤性肺胸部 (PTX) 诊断和管理在创伤护理中至关重要.
- 床边超声波 (BUS) 提供了早期PTX检测的潜力.
- 床边成像的实用性,包括BUS和仰卧胸部X射线 (CXR),用于引导管胸切除术 (TT) 需要进一步的证据.
研究的目的:
- 评估BUS和CXR的诊断准确性,单独和组合,用于预测创伤患者需要TT的需要.
- 为了比较BUS和CXR在检测PTX与CT扫描中的有效性.
主要方法:
- 从2017年到2020年在1级农村创伤设施中对成人创伤激活的回顾性分析.
- 所有被纳入的患者在抵达时都接受了CXR和BUS (eFast).
- 统计分析,包括麦克纳马的千平方测试和逻辑回归,将成像发现与需要的TT和CT扫描结果进行比较.
主要成果:
- 在602名被录取的患者中,210人需要TT. 阳性PTX检测率为BUS (16 FNs,98 FPs) 的21%,CXR (114 FNs,4 FPs) 的17%.
- 结合BUS和CXR在11.9%的患者 (140个FN,2个FP) 中发现了PTX.
- 与负结果相比,TT安置的几率比率在阳性BUS (22x),CXR (47x) 和组合 (70x) 中显著更高.
结论:
- 对BUS和CXR的PTX的阳性发现是对创伤患者需要TT的更强有力的预测因素,而不是单独使用任何一种模式.
- 组合成像增强了在创伤环境中对TT安置的决策过程.
- 进一步的研究可以完善结合床边成像在创伤PTX管理中的作用.
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