胃超声波在预测患上上胃肠道上部出血的患者的胃部内容的实用性
Simon Meredith1, Kevin Shayani1, Megan Buckley2
1Division of Pulmonary, Sleep & Critical Care Medicine, Lenox Hill Hospital/Northwell Health, New York, NY, USA.
胃点护理超声波 (POCUS) 可以在手术前可靠地评估胃的内容. 这种床边超声波具有很高的负预测值,有助于排除胃内容,并减少上部胃肠道出血的吸入风险.
科学领域:
- 胃肠病学 胃肠病学
- 关键护理医学 关键护理医学
- 医疗成像医学成像
背景情况:
- 胃点护理超声波 (POCUS) 帮助临床医生在重症监护病房输管前评估胃内含量.
- 评估胃含量对于降低诱导期间吸入风险至关重要,这可能会增加发病率和死亡率.
- 在上部胃肠道出血 (GIB) 时,在食管胃肠道透视 (EGD) 之前进行超声波评估可以帮助麻醉风险分层并评估正在进行的出血问题.
研究的目的:
- 为了比较胃POCUS在测量胃含量中的可靠性与上部GIB患者的EGD的黄金标准.
- 为了确定胃POCUS的灵敏度,特异性,正预测值 (PPV) 和负预测值 (NPV),用于检测胃含量.
主要方法:
- 使用比较性研究设计来评估通过EGD和床边超声波获得的胃含量测量.
- 该研究计算了POCUS与EGD相比的95%置信区间 (CI) 的灵敏度,特异性,PPV和NPV.
- 描述性统计数据被用来总结POCUS测量结果,特别是在EGD和POCUS对胃内容的评估不同的情况下.
主要成果:
- 与EGD相比,胃POCUS表现出75.0% (95%CI:19.4-99.4) 的灵敏度和76.1% (95%CI:61.2-87.4) 的特异性,用于检测胃中的内容.
- 对POCUS的负预测值 (NPV) 高达97.2% (95% CI: 85.5-99.9),表明其在排除胃内容的有效性.
- 阳性预测值 (PPV) 为21.4% (95% CI:4.7%-50.1%). 这是一个很好的预测值. 在不一致的病例中,中位数的POCUS测量值为97.8 (IQR:18.7-260.8).
结论:
- 胃超声波是一种潜在的有价值的工具,用于评估在EGD之前的胃内容,特别是在怀疑GIB的情况下.
- 胃POCUS表现出高的NPV,这使得它很有用,以排除胃内容的存在.
- 这些发现表明,胃POCUS可以告知临床决策在重症监护,潜在地减轻与疑似胃内容相关的吸入风险.
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