Accuracy of pleural puncture sites -: A prospective comparison of clinical examination with ultrasound
Accuracy of pleural puncture sites -: A prospective comparison of clinical examination with ultrasound
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DOI：
10.1378/chest.123.2.436
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发表时间：
2003-02-01
期刊：
影响因子：
9.6
通讯作者：
Solèr, M
中科院分区：
文献类型：
--
作者：
Diacon, AH;Brutsche, MH;Solèr, M
研究目的：探讨胸部超声对急性心绞痛的诊断价值；诊断性胸膜穿刺术（DPC）的临床检查。设计：前瞻性比较研究。单位：某三级教学医院肺科。患者和参与者：67名连续患者转介给30名不同程度经验的DPC医生。干预措施：根据临床数据和检查，医生决定是否以及在哪里进行DPC。选取的穿刺部位用。当存在大于或等于10毫米垂直于皮肤的液体时，超声检查被认为是准确的。测量和结果：255例中有172例（67%）建议穿刺部位。在超声检查中发现25个位置（15%）不准确，其中20个病例建立了不同的准确位置。83例（33%）医生无法定位穿刺部位。其中超声准确定位45例（54%），无法安全定位38例（46%）。总的来说，超声波在所有病例中预防了10%可能的意外器官穿刺，并将准确位置的率提高了26%。与超声作为“金标准”相比，临床检查确定合适穿刺部位的敏感性和特异性分别为76.6%和60.3%（阳性预测值为85.5%，阴性预测值为45.8%）。与不准确的临床部位选择相关的危险因素如下：少量积液（p < 0.001），胸片上有液体定位的证据（p = 0.01；相对危险度为7.8；95%可信区间为1.9 ~ 32.9），胸片上胸片上有明显的肋膈角（p < 0.001；相对危险度为7.0；95%可信区间为2.3 ~ 15.2）。有经验的医生并不比受过培训的医生表现得更好。结论：床边超声选择穿刺部位可提高DPC的成功率，降低并发症的发生率。医师经验不能预测所选穿刺部位的准确性。
Study objective: To assess the value of chest ultrasonography vs; clinical examination for planning of diagnostic pleurocentesis (DPC).Design: Prospective comparative study.Setting: Pulmonary unit of a tertiary teaching hospital. Patients and participants: Sixty-seven consecutive patients referred to 30 physicians of varying degrees of experience for DPC.Interventions: Based on clinical data and examination, physicians determined whether and where a DPC should be performed. Selected puncture sites were evaluated with. ultrasound and considered accurate when greater than or equal to 10 mm fluid perpendicular to the skin were present.Measurements and results: In 172 of 255 cases (67%), a puncture site was proposed. Twenty-five sites (15%) were found to be inaccurate on ultrasound examination, and a different, accurate site was established in 20 of these cases. Physicians were unable to locate a puncture site in 83 cases (33%). Among these, ultrasound demonstrated an accurate site in 45 cases (54%), while a safe tap was truly impossible in 38 cases (46%). Overall, ultrasound prevented possible accidental organ puncture in 10% of all cases and increased the rate of accurate sites by 26%. The sensitivity and specificity for identifying a proper puncture site with clinical examination compared to ultrasound as the "gold standard" were 76.6% and 60.3% (positive and negative predictive values, 85.5% and 45.8%, respectively). Risk factors associated with inaccurate clinical site selection were as follows: small effusion (p < 0.001), evidence of fluid loculation on chest radiography (p = 0.01; relative risk, 7.8; 95% confidence interval, 1.9 to 32.9), and sharp costodiaphragmatic angle on chest radiography (p < 0.001; relative risk, 7.0; 95% confidence interval, 2.3 to 15.2). Experienced physicians did not perform better than physicians in training.Conclusions: Puncture site selection with bedside ultrasonography increases the yield of and potentially reduces complication rate in DPC. Physician experience does not predict the accuracy of selected puncture sites.