ﻣﻘﺎﯾﺴﻪ روش ﺳﻮﻧﻮﮔﺮاﻓﯽ زﻣﺎن واﻗﻌﯽ داﺧﻞ ﺗﺮاﺷﻪ ای ﺑﺎ ﺳﺎﯾﺮ روش ﻫﺎی ﻣﺘﺪاول از ﻧﻈﺮ ﺗﺎﺋﯿﺪ ﻣﺤﻞ ﻗﺮارﮔﯿﺮی ﻟﻮﻟﻪ ﺗﺮاﺷﻪ

ﻣﻘﺪﻣﻪ: ﻣﺪﯾﺮﯾﺖ راه ﻫﻮاﯾﯽ در اورژاﻧﺲ از اﻫﻤﯿﺖ وﯾﮋهای ﺑﺮﺧﻮردار اﺳﺖ. ﻟﻮﻟﻪﮔﺬاری داﺧﻞ ﺗﺮاﺷﻪ اﺻﻠﯽ ﺗﺮﯾﻦ روش ﺑﺮﻗﺮاری ﯾﮏ راه ﻫﻮاﯾﯽ ﻣﻄﻤﺌﻦ اﺳﺖ. ﻗﺮار ﻧﮕﺮﻓﺘﻦ ﻟﻮﻟﻪ ﺗﺮاﺷﻪ در ﻣﺤﻞ ﻣﻨﺎﺳﺐ ﻣﻨﺠﺮ ﺑﻪ ﻣﺮگ و ﻣﯿﺮ زﯾﺎدی ﻣﯽﺷﻮد. ﺑﻨﺎﺑﺮ اﯾﻦ، ﻫﺪف از ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﺗﻌﯿﯿﻦ دﻗﺖ روش ﺳﻮﻧﻮﮔﺮاﻓﯽ زﻣﺎن واﻗﻌﯽ real-time از ﻧﻈﺮ ﻣﺤﻞ ﺻﺤﯿﺢ ﻟﻮﻟﻪﮔﺬاری در ﻣﻘﺎﯾﺴﻪ ﺑﺎ روشﻫﺎی ﻣﺘﺪاول در ﺑﯿﻤﺎران ﺑﺨﺶ اورژاﻧﺲ ﺑﯿﻤﺎرﺳﺘﺎن اﻣﺎم رﺿﺎی ﻣﺸﻬﺪ ﺑﻮد. روش ﮐﺎر: ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ از ﻧﻮع ﺗﻮﺻﯿﻔﯽ ﺗﺤﻠﯿﻠﯽ آﯾﻨﺪهﻧﮕﺮ در ﺗﻌﯿﯿﻦ ارزش ﺗﺸﺨﯿﺼﯽ ﺳﻮﻧﻮﮔﺮاﻓﯽ زﻣﺎن واﻗﻌﯽ ﺑﺮای ﺻﺤﺖ ﻟﻮﻟﻪﮔﺬاری ﺑﻮد. اﺳﺘﺎﻧﺪارد ﻟﻮﻟﻪﮔﺬاری ﺻﺤﯿﺢ، ﯾﺎﻓﺘﻪﻫﺎی ﺳﻤﻊ رﯾﻪ، ﺑﺮرﺳﯽ ﻣﻨﺤﻨﯽﻫﺎی وﻧﺘﯿﻼﺗﻮر و در ﺻﻮرت اﻣﮑﺎن ﻣﺸﺎﻫﺪه، ﻋﺒﻮر ﻟﻮﻟﻪ ﺗﺮاﺷﻪ از ﻃﻨﺎبﻫﺎی ﺻﻮﺗﯽ در ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪ. ﺗﺤﻠﯿﻞ دادهﻫﺎ ﺑﺮای ﺗﻌﯿﯿﻦ ﺣﺴﺎﺳﯿﺖ، وﯾﮋﮔﯽ، ارزش اﺧﺒﺎری ﻣﺜﺒﺖ و ﻣﻨﻔﯽ اﻧﺠﺎم ﺷﺪ. آزﻣﺎﯾﺶ ﻣﺜﺒﺖ ﺑﻪ ﻋﻨﻮان ﻋﺒﻮر ﻟﻮﻟﻪ اﻧﺪوﺗﺮاﮐﺌﯿﺎل ﺑﻪ داﺧﻞ ﻣﺮی ﻮﻟﻪﮔﺬاری اﺷﺘﺒﺎه در ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪ. ﺗﺠﺰﯾﻪ و ﺗﺤﻠﯿﻞ دادهﻫﺎ ﺑﻪ ﮐﻤﮏ ﻧﺮم اﻓﺰار spss ﻧﺴﺨﻪ 26 ﺑﺎ اﺳﺘﻔﺎده از آﻣﺎرﻫﺎی ﺗﻮﺻﯿﻔﯽ ﺷﺎﻣﻞ ﻣﯿﺎﻧﮕﯿﻦ، درﺻﺪ و اﻧﺤﺮاف ﻣﻌﯿﺎر و آزﻣﻮن ﺣﺴﺎﺳﯿﺖ و اﺧﺘﺼﺎﺻﯿﺖ و ﻧﻤﻮدار ﻧﺴﺒﺖ ﺷﺎﻧﺲ اﻧﺠﺎم ﺷﺪ.ﯾﺎﻓﺘﻪﻫﺎ: در ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ 52ﻧﻔﺮ ﺑﯿﻤﺎر ﺑﺮرﺳﯽ ﺷﺪﻧﺪ. ﺗﺎﯾﯿﺪ ﻟﻮﻟﻪﮔﺬاری داﺧﻞ ﺗﺮاﺷﻪ ﺑﻪ روش ﺳﻤﻊ ﻗﻔﺴﻪ ﺳﯿﻨﻪ در 30 ﻣﻮرد، ﻣﺸﺎﻫﺪه ﻣﻨﺤﻨﯽﻫﺎی وﻧﺘﯿﻼﺗﻮر در 26 ﻣﻮرد و ﻣﺸﺎﻫﺪه ﻃﻨﺎب ﻫﺎی ﺻﻮﺗﯽ در 37 ﻣﻮرد ﺗﺎﯾﯿﺪ ﺷﺪ. ﺑﺮ اﯾﻦ اﺳﺎس، ﺗﻌﺪاد 26 ﻧﻔﺮ ﻫﺮ ﺳﻪ روش ﺗﺎﯾﯿﺪ ﻟﻮﻟﻪﮔﺬاری داﺧﻞ ﺗﺮاﺷﻪ را داﺷﺘﻨﺪ. ﺳﻮﻧﻮﮔﺮاﻓﯽ ﻧﯿﺰ در 36 ﻣﻮرد ﺻﺤﺖ ﻟﻮﻟﻪ ﮔﺬاری را ﺗﺎﯾﯿﺪ ﮐﺮد. اﺳﺘﺎﻧﺪارد ﻃﻼﯾﯽ ﺑﻪ ﻣﺜﺎﺑﻪ ﻣﺜﺒﺖ ﺑﻮدن ﻫﺮ ﺳﻪ روش آزﻣﺎﯾﺶ و در ﻧﻈﺮ ﮔﺮﻓﺘﻦ ﻋﺪم ﻋﺒﻮر ﻟﻮﻟﻪ از ﺗﺮاﺷﻪ ﺑﻪ ﻋﻨﻮان ﻣﻌﯿﺎر ﺑﺮرﺳﯽ، ﺣﺴﺎﺳﯿﺖ ﺳﻮﻧﻮﮔﺮاﻓﯽ داﺧﻞ ﺗﺮاﺷﻪ ﺑﺮاﺑﺮ 96/15 درﺻﺪ و اﺧﺘﺼﺎﺻﯿﺖ آن 57/69 درﺻﺪ ﺑﻪ دﺳﺖ آﻣﺪ. ﻣﻘﺎدﯾﺮ ﻧﺴﺒﺖ اﺣﺘﻤﺎل ﺷﺎﻧﺲ ﻣﺜﺒﺖ و ﻣﻨﻔﯽ و ﻫﻤﭽﻨﯿﻦ ارزش ﭘﯿﺶ ﺑﯿﻨﯽ ﻣﺜﺒﺖ و ﻣﻨﻔﯽ ﺑﻪ ﺗﺮﺗﯿﺐ ﺑﺮاﺑﺮ 2/27 درﺻﺪ، 0/07 درﺻﺪ، 69/44 درﺻﺪ و 93/75 درﺻﺪ ﺑﻮد. ﻧﺘﯿﺠﻪﮔﯿﺮی: آزﻣﺎﯾﺶ ﺳﻮﻧﻮﮔﺮاﻓﯽ ﺗﺮاﺷﻪ دارای ارزش ﺑﺎﻻﺗﺮی از ﻧﻈﺮ ﺣﺴﺎﺳﯿﺖ ﺑﺮای ﺗﺸﺨﯿﺺ ﺧﻄﺎﻫﺎی ﻟﻮﻟﻪﮔﺬاری ﺗﺮاﺷﻪ اﺳﺖ. ﺑﻪ ﻃﻮر ﮐﻠﯽ، ﯾﮏ آزﻣﺎﯾﺶ ﺗﺸﺨﯿﺼﯽ ﺑﺎ ﺣﺴﺎﺳﯿﺖ ﮐﻢ و ارزش ﭘﯿﺶﺑﯿﻨﯽ اﻧﺪک ﺑﻪ دﻟﯿﻞ اﯾﻦ ﮐﻪ ﻣﯽﺗﻮاﻧﺪ ﺑﻪ ﺗﺸﺨﯿﺺ ﺻﺤﯿﺢ از دﺳﺖ رﻓﺘﻪ و درﻣﺎنﻫﺎی ﻏﯿﺮﺿﺮوری ﺑﺎ ﻋﻮاﻗﺐ ﻣﻨﻔﯽ ﺑﺮای ﺑﯿﻤﺎر ﻣﻨﺠﺮ ﺷﻮد ﻣﺸﮑﻞﺳﺎز ﺧﻮاﻫﺪ ﺑﻮد. اﯾﻦ ﻣﻮﺿﻮع ﺑﺎﯾﺪ در ﻣﻄﺎﻟﻌﺎت ﺑﯿﺸﺘﺮی ﺑﺮرﺳﯽ ﺷﻮد.

comparison of intra-endotracheal real-time ultrasound method with other conventional methods in for confirming the location of endotracheal tube

objective: purpose: the purpose of this study is to compare the accuracy of the real-time ultrasound method in determining the correct location of intubation, compared to conventional methods, in the patients of the emergency department of imam rezai hospital in mashhad.methods materials: this is a descriptive-analytic prospective study to determine the diagnostic value of real-time ultrasound for the accuracy of intubation. the standard test to determine the correct intubation is lung auscultation findings, checking ventilator curves and, if observed, passing the tracheal tube through the vocal cords. data analysis was done to calculate sensitivity, specificity, positive and negative news value. a positive test was considered as passing the endotracheal tube into the esophagus (wrong tube placement). results: by observing ventilator curves, confirmation of endotracheal intubation was confirmed in 26 cases. observation of vocal cords was confirmed in 37 cases. based on this, 26 patients had all three approval scales for endotracheal intubation. ultrasound confirmed the correctness of intubation in 36 cases.conclusion: in short, tracheal ultrasound test has a higher specificity than sensitivity for detecting tracheal intubation errors, which means that it is more effective in correctly identifying patients whose intubation errors did not occur than those who did. it is more reliable. however, the high rate of intubation errors in our study affects these results.