摘要
目的探讨肺部超声(lung utrasonography,LUS)评分在急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者早期病情评估中的价值。方法选取2016年7月～2018年1月入住鄞州医院ICU和EICU且符合柏林标准诊断的ARDS患者,根据氧合指数(oxygenation index,OI)将ARDS患者分为轻中度组(100 mmHg<OI≤300 mmHg)和重度组(OI≤100 mmHg)。记录患者临床资料及第1天(D1)、第2天(D2)、第3天(D3)LUS评分与OI、急性生理学与慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluation II,APACHE-Ⅱ)、序贯器官衰竭评分(sequential organ failure assessment,SOFA),通过Pearson相关分析讨论LUS评分与OI、APACHE-Ⅱ、SOFA评分之间的相关性。ROC曲线分析LUS评分判断ARDS患者病情严重程度及敏感性、特异性。结果收集ARDS患者33例,72 h死亡3例。D1 LUS评分与OI负相关(r=-0.419,P=0.015),与APACHE-Ⅱ评分正相关(r=0.414,P=0.017)、与SOFA评分正相关(r=0.477,P=0.005),且相关性较好。D2、D3时,LUS评分与APACHE-Ⅱ评分、SOFA评分依然具有较好的正相关性(D2 r值分别为:0.392、0.368,P值分别为0.027、0.038;D3 r值分别为0.466、0.390,P值分别为0.010、0.033)。通过LUS评分ROC曲线下面积(AUC=0.933)分析得到,以20.5为阈值判断重度ARDS敏感性为89%,特异性为79%。结论 LUS评分可以很好地反映ARDS患者肺组织失气化改变及肺通气面积的缺失,且具有良好的信度和稳定性,可以早期评估ARDS患者病情严重程度。
Objective To investigate the value of lung utrasonography(LUS)score in the early assessment of patients with acute respiratory distress syndrome(ARDS).Methods Patients who were admitted to the Yinzhou Hospital ICU and EICU from July 2016 to January 2018 and who met the Berlin criteria for diagnosis of ARDS were selected.Patients with ARDS were divided into mild to moderate group(100 mmHg<OI≤300 mmHg)and severe group(OI≤100 mmHg)according to oxygenation index(OI).The patient's clinical data and the LUS score and OI,acute physiology and chronic health evaluationⅡ(APACHE-Ⅱ),and sequential organ failure assessment(SOFA)at the first day(D1),the second day(D2),and the third day(D3)were recorded,and the correlation between LUS score and OI,APACHE-Ⅱ,and SOFA scores was analyzed by Pearson correlation analysis.The LUS score was analyzed by ROC curve to determine the severity,sensitivity and specificity of patients with ARDS.Results 33 patients with ARDS were collected and 3 patients died in 72 hours.On D1,the LUS score was negatively correlated with OI(r=-0.419,P=0.015),positively correlated with APACHE-Ⅱscore(r=0.414,P=0.017),and positively correlated with SOFA score(r=0.477,P=0.005),and the correlation was close.On D2 and D3,the LUS score still had a good positive correlation with the APACHE-Ⅱscore and the SOFA score(r values on D2 were:0.392,0.368,P values were 0.027,0.038,respectively;r values on D3 were:0.466,0.390,P values were 0.010,0.033,respectively).The area under the ROC curve of the LUS score(AUC=0.933)was analyzed and the sensitivity of severe ARDS was 89%and the specificity was 79%with a threshold of 20.5.Conclusion The LUS score can well reflect the change of lung tissue with loss of air and the deficiency of lung ventilation area in patients with ARDS,and it has good reliability and stability,which can be used to assess the severity of ARDS.
作者
张磊
陶洋
姚丽娜
周成杰
安敏飞
俞万钧
陈国忠
ZHANG Lei;TAO Yang;YAO Lina;ZHOU Chengjie;AN Minfei;YU Wanjun;CHEN Guozhong(ICU,Yinzhou Hospital Affiliated to Ningbo University Medical College,Ningbo 315040,China;Rome of Clinical Record,Yinzhou Hospital Affiliated to Ningbo University Medical College,Ningbo 315040,China;Department of Respiratory,Yinzhou Hospital Affiliated to Ningbo University Medical College,Ningbo 315040,China)
出处
《中国现代医生》
2019年第1期28-32,共5页
China Modern Doctor
基金
浙江省医药卫生科技计划项目(2018KY753)
关键词
肺部超声
急性呼吸窘迫综合征
氧合指数
血管外肺水
Lung utrasonography
Acute respiratory distress syndrome
Oxygenation index
Extravascular lung edema
