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重症超声病理生理导向急诊检查方案及诊疗流程(POCCUE)在重症患者急性呼吸循环障碍中的价值研究

The Clinical Value of the Pathophysiology Oriented Critical Care Ultrasound Exam (POCCUE) Protocol in Acute Respiratory and Circulatory Compromise of Critically Ill Patients

    摘要
  • 摘要:
      目的  探讨重症超声病理生理导向急诊检查方案及诊疗流程(POCCUE方案)对重症患者急性呼吸循环障碍的诊疗准确性。
      方法  前瞻性纳入2018年3~4月入住四川大学华西医院ICU，出现急性呼吸循环障碍的患者。针对急性呼吸循环障碍的本质(病理生理改变)设计POCCUE方案:第一部分为检查方法，包含应用超声切面和相应指标获取，其具体评估分为肺部超声和心脏超声检查指标；第二部分为综合分析，以第一部分的检查评估得出急性呼吸循环障碍的病理生理改变结果，同时按照流程制定病理生理和病因的诊断和初步治疗手段。比较POCCUE方案组和传统治疗组的诊疗计划，验证POCCUE方案的临床价值。
      结果  最终共纳入82例次进行分析。与传统治疗组相比，应用POCCUE方案能够提高急性呼吸循环障碍病理生理诊断和支持治疗准确率(93.90% vs. 68.29%, P < 0.01；93.90% vs. 62.20%, P < 0.01)、提高临床层面的诊断和治疗准确率(93.90% vs. 68.29%, P < 0.01；93.90% vs.62.20%, P < 0.01)。
      结论  POCCUE方案较传统诊疗方法在急性呼吸循环障碍中可能有着更高的诊断及治疗准确率，有临床应用于重症监测、评估和治疗的潜力。

     

    Abstract:
      Objective  The aim of this study is to explore the diagnostic and therapeutic accuracy of pathophysiology and clinic oriented critical care ultrasound exam (POCCUE) protocol in acute respiratory and circulatory compromise of critically ill patients.
      Methods  Prospectively included patients with acute respiratory and circulatory compromise from ICU of West China Hospital of Sichuan University from March to April 2018. The POCCUE protocol designed according to the pathophysiological changes of acute respiratory and circulatory disorders includes: the first part is the acquiring an ultrasound section and measuring corresponding indicators including pulmonary and echocardiographic indicators; the second part is a comprehensive analysis according to the former examination which evaluates the pathophysiological changes of acute respiratory and circulatory disorders, and then establish the initial etiology diagnosis and start treatment. The clinical value of the POCCUE protocol, including the accuracy of diagnosis, and the differences in treatment was verified by comparing the clinical outcome with the traditional treatment group.
      Results  A total of 82 subjects were used for statistics. Compare with the traditional group, POCCUE can notably increase the diagnostic and therapeutic accuracy of clinic and pathophysiology (diagnostic accuracy: 93.90% vs. 68.29%, P < 0.01; therapeutic accuracy: 93.90% vs. 62.20%, P < 0.01).
      Conclusion  The POCCUE has a higher accuracy of diagnosis and treatment for patients with acute respiratory and circulatory compromise.

     

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