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重症超声是在重症医学理论指导下,运用超声技术,针对重症患者,以问题导向的、多目标整合的动态评估过程,是确定重症治疗,尤其是血流动力学治疗方向及调整精细治疗的重要手段[1,2,3]。重症超声不同于传统的诊断超声,实施者和影像结果解读者均为重症医学专业人员,以评估脏器及系统的病理生理改变和病因学为核心,以重症医学诊疗思路整合上述临床信息,床旁实现即时诊断和滴定治疗、评估疗效以改善患者结局[4,5,6,7,8,9,10,11,12]。但应充分认识到重症超声的发展一方面离不开传统超声的快速进步与发展,另一方面,重症医学赋予了超声技术临床应用新的内涵,重症超声是传统的技术,新的应用方法。重症超声具有以问题导向为基础、实时实地、多系统整合、多目标流程化实施等特点。2016年发布的"中国重症超声专家共识"针对重症超声的理念、实施与应用提出了共识性建议。值得强调的是,重症超声的客观准确评估与实施需要超声图像获取的标准化,需要建立重症超声的技术规范及流程化方案;同时,重症医学专业医生接受重症超声规范化培训更需要相应的规范。建立技术规范是重症超声质量控制与持续提高的根基,为未来拓展建立详尽的重症临床应用规范创造重要条件。
Critical ultrasonography(CUS) is different from the traditional diagnostic ultrasound, the examiner and interpreter of the image are critical care medicine physicians. The core content of CUS is to evaluate the pathophysiological changes of organs and systems and etiology changes. With the idea of critical care medicine as the soul, it can integrate the above information and clinical information, bedside real-time diagnosis and titration treatment, and evaluate the therapeutic effect so as to improve the outcome. CUS is a traditional technique which is applied as a new application method. The consensus of experts on critical ultrasonography in China released in 2016 put forward consensus suggestions on the concept, implementation and application of CUS. It should be further emphasized that the accurate and objective assessment and implementation of CUS requires the standardization of ultrasound image acquisition and the need to establish a CUS procedure. At the same time, the standardized training for CUS accepted by critical care medicine physicians requires the application of technical specifications, and the establishment of technical specifications is the basis for the quality control and continuous improvement of CUS. Chinese Critical Ultrasound Study Group and Critical Hemodynamic Therapy Collabration Group, based on the rich experience of clinical practice in critical care and research, combined with the essence of CUS, to learn the traditional ultrasonic essence, established the clinical application technical specifications of CUS, including in five parts: basic view and relevant indicators to obtain in CUS; basic norms for viscera organ assessment and special assessment; standardized processes and systematic inspection programs; examples of CUS applications; CUS training and the application of qualification certification. The establishment of applied technology standard is helpful for standardized training and clinical correct implementation. It is helpful for clinical evaluation and correct guidance treatment, and is also helpful for quality control and continuous improvement of CUS application.
Critical ultrasonography; Clinical application; Technical specification
Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
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