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題 名 | 胸腔超音波於診斷氣胸時的應用=Chest Sonography in Diagnosing Pneumothorax |
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作 者 | 林鎮均; 林嘉謨; 江俊松; 高尚志; | 書刊名 | 胸腔醫學 |
卷 期 | 16:1 2001.03[民90.03] |
頁 次 | 頁22-27 |
分類號 | 415.434 |
關鍵詞 | 胸腔超音波; 氣胸; 呼吸器; 重症; Sonography; Pneumothorax; Gliding sign; Comet-tail airtifact; Mechanical ventilator; Critcal care; |
語 文 | 中文(Chinese) |
中文摘要 | Wernecke等人於1987年首次提出超音波於診斷氣胸上的應用。我們共收集了25例門診病患及12例使用呼吸器的重症病患,臨床上以不明原因的單側胸痛來求診或重症病患出現突發性氣促或尖峰氣道壓升高合併單側或雙側呼吸音變小,或胸部X光有疑似氣胸但無法確定診斷者進行緊急胸腔超音波檢查,並進一步分析胸腔超音波於診斷使用呼吸器病患發生張力性氣胸時的應用。 我們將同一側的gliding sign和comet-tail artifact同時消失作為超音波的診斷標準。而出現下例情況之一者則當作氣胸的確定診斷:X光片有明顯的氣胸出現者、緊急插入細針或胸管時有噴射狀氣體出現且臨床症狀明顯改善者、插入胸管後有持續性漏氣者。 所有被列入研究的門診和重症病例的超音波敏感度為85.7%,特異度為100%,陽性預測值為100%,陰性預測值為84.2%。門診病患的超音波敏感度為80%,特異度為100%,陽性預測值為100%。 在本研究中我們發現,超音波在氣胸,特別是張力性氣胸的診斷上有很高的敏感度與特異性。因此我們建議超音波可被當作診斷氣胸,特別是張力性氣胸的第一線檢查工具,它可以提供精確的診斷率,並可減少不必要的胸管插入術。 |
英文摘要 | Werneke et al. first presented the diagnosis of pneumothorax by songraphy in 1987. we enrolled 25 outpatients who complained of unexplained unilateral chest pain and 10 mechanically-ventilated patients presenting with one of the following: a sudden onset of shortness of breath, an abrupt increase of peak airway pressure combined with, a unilateral or bilateral decrease of breath sound, or a suspicion of pneumothorax on antero-posterior (AP) view chest X-ray, who could not be definitively diagnosed. We performed emergency chest sonography on these patients for the evaluation of penumothorax. In this study, we attempt to analyze the role of chest sonography in the diagnosis of pneumothorax. We defined the disappearance of both the "gliding sign" and the "comet-tail" as positive ultrasonic findings of pneumothorax. The gold standard we used was one of following: obvious pneumothorax on the postero-anterior (PA) or lateral decubitus view of the chest X-ray, a jet air stream exit immediately after chest tube or large-bore needle insertion, or continuous air leakage after chest tube insertion. The overall sensitivity was 85%, the specificity was 100%, the positive predictive value was 100%, and the negative predictive value was 100%. In the outpatient population, the sensitivity was 80%, the specificity was 100%, the positive predictive value was 100%, and the negative predictive value was 76.9%. In the mechanically-ventilated population, the sensitivity, specificity, positive predictive value, and negative predictive value were all 100%. We conclude that sonography is both highly sensitive and specific for the diagnosis of pneumothorax. Therefore, we recommend the use of sonography as the first-line diagnostic tool in patients suspected of developing pneumothorax, especially tension pneumothorax, to avoid unnecessary chest tube insertion. |
本系統中英文摘要資訊取自各篇刊載內容。