摘要
目的探讨急诊科医生使用便携式超声评估左心室收缩功能的准确性。方法前瞻性、观察性研究，连续选取2011年11月至2012年2月期间以急性呼吸困难主诉收入上海交通大学医学院附属新华医院急诊科的81例患者，排除创伤和急性心肌梗死患者。4名急诊科医生经过强化超声心动图培训后，使用便携式超声仪对81例患者行床旁超声心动图检查，获取左胸骨旁长短轴、心尖四腔和剑突下二维图像，使用目测法估计左心室射血分数，将患者左心室收缩功能分为正常、轻中度减低和严重减低三个类别，与超声科医生的超声心动图测量结果相比较。使用SPSS13．0统计软件进行kappa检验来分析二者的诊断一致性。结果以超声科医生测量的左心室射血分数为“金标准”，急诊科医生区分左心室收缩功能正常和减低的准确率为89％，急诊科医生判断患者左心室收缩功能减低的阳性预测值为83％，阴性预测值为93％，急诊科医生和超声科医生诊断一致性检验kappa系数为0．77（95％CI：0．70～0．84，P〈0．01）。对左心室收缩功能三个不同类别的判断，急诊科医生的准确率为84％，诊断一致性检验kappa系数为0．71（95％CI：0．64—0．78，P〈0．01）。结论急诊科医生经过超声心动图强化培训后，使用便携式超声仪能够准确地评估左心室收缩功能。
Objective To determine the capability of emergency physicians （EPs） after goal- directed training to make accurate judgement and assessment of left ventricular systolic function （LVSF） as they own manipulated the hand-held echocardiography. Methods Eighty-one patients with acute dyspneic symptom admitted into emergency department of Xinhua Hospital Affiliated to Shanghai T;aotong University School of Medicine from November 2011 to February 2012 were enrolled for a prospective, observational study. Patients with a history of trauma or acute myocardial infarction diagnosed by electrocardiogram were excluded. Four EPs after a intensive course of goal-oriented training in a good command of trans-thoracic echocardiography （TIE） in 81 emergency patients using hand-held echocardiography. EPs attempted to obtain images at the parasternal （long and short axis ）, apical, and subcostal positions, and visually estimated left ventricular ejection fraction （LVEF） and categorized LVSF as normal function, mild or moderate or severely depressed function. The results of echocardiographic LVEF got by EPs were compared quntitatively with those measured by an professional eehocardiographer. The kappa statistical test by using SPSS version 13.0 software was used to allow for comparison in agreement between EPs and the professionalechocardiographer＇ s interpretations of TTE findings. Results Using the results of rIFE measured by the professional eehocardiographer as a ＂ gold standard＂, EPs correctly distinguished the normal LVSF from decreased LVSF in 89% patients. The rate of positive predictive value for the EPs identifying any abnormality in LV function was 83% and the rate of negative predictive value was 93%. The kappa coefficient for the agreement between EPs and the professional echocardiographer＇ s interpretations for any abnormality in LV function was 0. 77 （ 95% CI： O. 70 - 0. 84, P 〈 0. 01 ）. EPs correctly placed LV function into one of three categories in 68 of 81 cases （84%） , The ka
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2013年第5期526-529,共4页
Chinese Journal of Emergency Medicine
关键词
左心室功能
急诊
床旁
超声心动图
便携式超声仪
Left ventricular function
Emergency
Bedside
Echocardiography
Hand-held uhrasound
