床边超声心动图检查在首诊心血管急危重症中的应用价值

目的:探讨床边超声心动图检查在首次诊断心血管急危重症疾病中的应用价值及操作体会。方法:回顾性分析我院2010-01-2010-12期间行急诊床边超声心动图检查共271例患者的资料。结果:床边超声心动图检查的阳性率为44.3%,其中有节段性室壁运动异常的急性冠状动脉综合征94例(包括室壁瘤破裂1例),瓣膜性疾病6例,心包积液5例,主动脉夹层3例,感染性心内膜炎赘生物2例,先天性心脏病3例,心房占位性病变4例,其他3例。因床边超声心动图检查首次确诊疾病,修正临床治疗,甚至挽救患者生命的有20例。结论:对症状不典型、初诊为急性冠状动脉综合征的主动脉夹层,及时进行床边超声心动图检查可起到鉴别诊断、改变治疗方案的作用;对表现为胸闷或气促的心包大量积液患者可明确诊断,指导心包穿刺引流;对高度怀疑的急性肺栓塞,床边超声心动图检查可现场动态观察临床抢救是否有效。

Value of bedside echocardiography for critical cardiovascular diseases

Objective:To assess the clinical value of bedside echocardiography for critical cardiovascular diseases and sum up its operate tips.Method:The clinical data from bedside echocardiography in 271 patients with critical cardiovascular disease from January to December in 2010 in the hospital were retrospectively analyzed by using LOGIQ (GE) bedside ultrasound instrument or IE33(PHILLIP) ultrasound instrument.Result:There was 44.3% positive rate in the bedside echocardiography results,including 94 patients who had abnormal segmental motion in left ventricular wall with acute coronary syndroms,six patients with valvular diseases,five patients with pericardial effusion,three patients with arotic dissection,two patients with infective endocarditis,three patients with congenital heart diseases,four patients with atrail masses and three patients with other cardiac diseases.Among them,the first diagnosis of 20 patients was corrected,then therapeutic strategy was changed,even the patients’ lives were saved by bedside echocardiography.Conclusion:Bedside echocardiography can evaluate whether the patients with acute coronary syndromes have abnormal segmental wall movement and if their heart function works normally.It can also play a role in differential diagnosis and therapeutic plan for,who were diagnosed acute coronary syndroms firstly since untypical symptom.It can help to confirm the diagnosis and guide the puncture and drainage operation for the patients with large pericardial effusion,who had chest distress or dispnea.It can observe lively whether the emergency treatment was effective for the patients who were suspected highly with acute pulmonary embolism.