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成人腹部和胸部创伤的急诊超声

Authors
Manoj Pariyadath, MD
Greg Snead, MD
Section Editor
Maria E Moreira, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM
Translators
张波, 副主任医师

引言

自从第二次世界大战期间被用作一种诊断工具以来，超声检查在评估创伤患者方面的作用越来越重要。1996年提出了腹部创伤超声重点评估(Focused Abdominal Sonography for Trauma)这一术语，用于描述一套标准的创伤患者评估的超声检查方法。一年后，该术语的含义被修订为创伤超声重点评估(Focused Assessment with Sonography for Trauma, FAST)，首字母缩略词仍为FAST，以反映超声在腹部之外其他部位的应用。

本文将总结在腹部或胸部创伤患者中，超声检查的操作和解读。创伤的处理(包括腹部和胸部损伤的处理)将单独讨论。 (参见“成人创伤的早期处理”和“成人钝性胸部损伤的初步评估和处理”和“成人胸部穿透伤的初始评估和处理”和“成人腹部钝挫伤的初始评估和处理”和“成人腹部枪伤的初步评估和处理”和“成人腹部刺伤的初步评估及处理”)

创伤超声重点评估

概述 — 在成人创伤患者中，超声是一种重要的初始筛查检查。然而，对于存在令人担忧的腹部或胸部症状或体征的患者，在确定其具体损伤的情况时，经常需进行更敏感的影像学检查，不能用超声检查替代这些检查。如果血流动力学稳定，多数此类患者应进行计算机断层扫描(computed tomography, CT)。对于通过超声检查发现存在腹腔内出血的血流动力学不稳定的患者，接下来通常直接进行剖腹手术。

对于血流动力学不稳定、无明确出血原因且初始超声检查的结果为阴性(即没有腹腔内积液)的患者，根据临床情况可能需进行诊断性腹腔穿刺或血管造影。例如，超声在严重骨盆骨折患者评估中的作用通常更有限，因为超声检测盆腔出血的敏感性较低、不能识别腹膜后出血、不能区分血液和尿液。此类患者的处理将单独讨论。 (参见“骨盆创伤：初步评估与处理”，关于‘初步处理’一节)

在创伤患者的初始检查和复苏阶段进行的超声评估被称为FAST[1,2]。当在FAST中增加评估气胸的视图时，可使用扩展的FAST检查(E-FAST)。

                               

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Literature review current through: 2017-06 . | This topic last updated: 2016-10-21.
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