PDF(Pubmed)
Abstract：
Background/Objectives: Chest X-ray (CXR) is currently the most used investigation for clinical follow-up after major noncardiac thoracic surgery. This study explores the use of lung ultrasound (LUS) as an alternative to CXR in the postoperative management of patients who undergo major thoracic procedures. Methods: The patients in our cohort were monitored with both a CXR and a lung ultrasonography after surgery and the day after chest drain removal. The LUS was performed by a member of the medical staff of our unit who was blinded to both the images and the radiologist\'s report of the CXR. Findings were compared between the two methods. Results: In the immediate postoperative evaluation, 280 patients were compared, finding general agreement between the two procedures at 84% (kappa statistic, 0.603). The LUS showed a sensibility of 84.1%, a specificity of 84.3%, a positive predictive value (PPV) of 60.9%, and a negative predictive value (NPV) of 94.8%. We evaluated 219 out of 280 patients in the postdrainage-removal setting due to technical issues. Concordance between the methods in the postdrainage-removal setting was 89% (kappa statistic, 0.761) with the LUS demonstrating an 82.2% sensibility, a 93.2% specificity, a PPV of 85.7%, and an NPV of 91.3%. Conclusions: The results of this study showed a substantial agreement between LUS and CXR, suggesting that the LUS could reduce the number of X rays in certain conditions. The high NPV allows for the exclusion of PNX and pleural effusion without the need to expose patients to radiation. Discrepancies were noted in cases of mild pneumothorax or modest pleural effusion, without altering the clinical approach.
摘要：
背景/目的：胸部X线检查（CXR）是目前最常用的非心脏胸部手术后的临床随访研究。这项研究探讨了在接受主要胸部手术的患者的术后管理中，使用肺超声（LUS）代替CXR。方法：我们队列中的患者在手术后和胸腔引流术后第二天接受CXR和肺部超声检查。LUS由我们单位的一名医务人员执行，他对CXR的图像和放射科医生的报告视而不见。比较两种方法的结果。结果：在术后立即评估中，280例患者进行对比,在84%的两个程序之间发现普遍同意(kappa统计，0.603）。LUS的灵敏度为84.1%,特异性为84.3%，阳性预测值(PPV)为60.9%，阴性预测值（NPV）为94.8%。由于技术问题，我们评估了280名患者中的219名。在排水去除后设置中，方法之间的一致性为89%(卡帕统计，0.761)，LUS显示82.2%的灵敏度，93.2%的特异性，PPV为85.7%，净现值为91.3%。结论：这项研究的结果表明LUS和CXR之间有很大的一致性，这表明LUS可以在某些条件下减少X射线的数量。高NPV允许排除PNX和胸腔积液，而无需将患者暴露于辐射。在轻度气胸或中度胸腔积液的病例中发现差异，而不改变临床方法。
