焦點式超音波(Point-of-Care Ultrasound, POCUS)由臨床醫師在床邊即時掃描，結合臨床症狀與檢驗數據，以快速協助診斷與處置，近年在基層醫療日益受到關注。由於可攜式超音波設備不斷進步且價格趨於平易近人，再加上美國、台灣等地逐步將超音波課程納入家庭醫學訓練與醫學院教育，使更多基層醫師得以熟練此技術，並於日常臨床應用。
本文以腎絞痛(renal colic)的評估為例，探討在基層利用POCUS偵測結石與腎盂積水(hydronephrosis)時，如何判斷結石可能的自然排出率以及是否需要進一步檢查或轉診。雖然無顯影劑電腦斷層(NCCT)是診斷尿路結石的黃金標準，超音波在排除大結石及偵測腎盂積水方面仍有顯著優勢，特別有助於分辨結石大小與阻塞程度。
實際操作時，可選擇曲線陣列(curvilinear)或相位式陣列(phased array)探頭，配合適當的病人姿勢，即可在床邊迅速評估腎臟、輸尿管與膀胱。若發現高回聲並伴隨後方聲音陰影，且出現輕至中度腎盂積水，可先以保守及排石治療為主；若結石疑似較大或病情惡化，則應考慮NCCT檢查與專科介入。
STONE-PLUS決策模式是結合STONE score與超音波檢查，若風險低且未見腎盂積水，則可大幅降低有症狀結石的可能性；若風險高或發現明顯腎盂積水，則需安排進一步影像檢查或轉診泌尿科。總體而言，POCUS在基層診療具有即時、低成本與無輻射的特點，可幫助臨床醫師更精準地診斷並減少不必要的轉診與影像暴露。隨著儀器持續進化與教育普及，POCUS勢必在基層醫療中扮演更關鍵的角色。
(台灣家醫誌2025; 35: 151-166) DOI: 10.53106/168232812025093503002
 
關鍵詞： 焦點式超音波、基層醫療、尿路結石、腎絞痛、STONE score

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¹秀傳醫療社團法人彰化秀傳紀念醫院醫學教育部
²秀傳醫療社團法人彰化秀傳紀念醫院家庭醫學科
受理日期：114年1月17日 修改日期：114年2月17日 同意刊登：114年4月18日
^*通訊作者：張富勝 通訊地址： 彰化市中山一段542號
E-mail：c0952328882@gmail.com
 

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Development and Clinical Applications of Point-of-Care Ultrasound in Primary Care: The Case of Renal Colic Evaluation
 
Shao-Min Huang¹, Yu-Ching Li² and Fu-Sheng Chang^2*
 

Point-of-care ultrasound (POCUS) is a bedside imaging modality that allows physicians to integrate real time imaging data alongside clinical symptoms and laboratory findings to assist with rapid diagnosis and management. In recent years, advancements in portable ultrasound technology and improved accessibility have facilitated its incorporation into primary care settings, particularly within family medicine training programs in Taiwan and the United States.
This article explores the application of POCUS in evaluating renal colic, focusing on its utility in detecting urinary stones and assessing hydronephrosis to guide decisions regarding further imaging or specialist referral.While non-contrast computed tomography (NCCT) remains the gold standard for diagnosing urinary stones, POCUS offers significant advantages in identifying large stones, assessing obstruction severity, and determining the need for timely intervention, making it a valuable tool for initial assessment.
The STONE-PLUS clinical pathway integrates the STONE score with ultrasound findings of hydronephrosis to stratify patients into low-, moderate-, and high-risk groups. With enhanced diagnostic accuracy, this model helps reduce unnecessary CT scans, particularly in low-risk patients without hydronephrosis.
Thanks to its real-time immediacy, portability, and cost-effectiveness, POCUS has the potential to improve diagnostic accuracy and guide clinical decision-making for renal colic patients in primary care. However, further education and systematic training will be critical in addressing barriers such as operator skill gaps and resource limitations, thereby ensuring broader adoption of POCUS as a routine diagnostic tool in primary care.
(Taiwan J Fam Med 2025; 35: 151-166) DOI: 10.53106/168232812025093503002
 
Key words: nephrolithiasis, point-of-care ultrasound, primary care, renal colic, STONE score
 

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¹Department of Medical Education, Show Chwan Memorial Hospital, Changhua, Taiwan
²Department of Family Medicine, Show Chwan Memorial Hospital, Changhua, Taiwan
Received: January 17, 2025; Revised: February 17, 2025; Accepted: April 18, 2025.
^*Corresponding author