摘要
目的应用床旁肺部超声评价急性呼吸窘迫综合征(ARDS)患者的肺水肿情况,探讨其在指导ARDS患者肺部治疗中的临床应用价值。方法将60例ARDS患者随机分为肺部超声组和对照组,每组各30例,记录其入科时及第7天的相关数据,包括APACHEⅡ评分、白细胞计数(WBC)、降钙素原(PCT)、血管外肺水指数、氧合指数、机械通气治疗时间,以及患者的7 d好转率等;肺部超声组记录治疗前后声像图变化及肺部超声评分。采用Pearson相关分析法分析肺部超声评分与APACHEⅡ评分、血管外肺水指数及氧合指数间的关系。绘制受试者工作特征(ROC)曲线分析肺部超声评分评估ARDS患者血管外肺水的诊断效能,计算曲线下面积。结果①两组治疗前APACHEⅡ评分、WBC、PCT、血管外肺水指数、氧合指数比较差异均无统计学意义,治疗7 d后两组患者均有改善,肺部超声组改善更明显,机械通气时间较对照组更短(P<0.05);②肺部超声组患者7 d好转率较对照组高(66.7%vs.46.7%,P<0.05);③肺部超声组治疗前肺部超声评分(28.5±2.5)分,治疗7 d后肺部超声评分(13.1±8.1)分,差异有统计学意义(P<0.05)。④肺部超声评分与APACHEⅡ评分和血管外肺水指数均呈正相关(r=0.928、0.818,均P<0.01),与氧合指数呈负相关(r=-0.939,P<0.01)。⑤以肺部超声评分13分为截断值,评估ARDS患者血管外肺水情况的ROC曲线下面积0.937,敏感性和特异性分别为100%和73.1%。结论肺部超声可有效评估ARDS患者肺水肿的严重程度,并应用于ARDS患者评估病情、管理病情、预测预后等方面,具有较好的临床应用价值。
Objective To explore the value of bedside pulmonary ultrasound in evaluating pulmonary edema for patients with ARDS and guiding lung therapy for patients with acute respiratory distress syndrome(ARDS).Methods Sixty ARDS patients were randomly divided into the pulmonary ultrasound group and the control group,with 30 patients in each group.The data of the patient’s admission and the 7th day were recorded,including APACHEⅡscore,WBC,PCT,extravascular lung water index,oxygenation index,mechanical ventilation time and 7-day improvement rate.While pulmonary ultrasound scores before and after treatment were recorded in the pulmonary ultrasound group.Pearson correlation analysis was used to analyze the relationship between lung ultrasound score and APACHEⅡscore,extravascular lung water index and oxygenation index.Results①There were no significant difference in APACHEⅡscore,oxygenation index,extravascular lung water index,WBC and PCT between the two groups before treatment.After 7 d of treatment,both groups of patients improved,the improvement in pulmonary ultrasound group was more obvious,and the mechanical ventilation time was shorter than that of control group(P<0.05).②The 7-day improvement rate of pulmonary ultrasound group was higher than that of the control group(66.7%vs.46.7%,P<0.05).③In the pulmonary ultrasound group,the pulmonary ultrasound score after treatment(13.1±8.1)was significantly lower than that before treatment(28.5±2.5),the difference was significant(P<0.05).④The pulmonary ultrasound score was positively correlated with APACHEⅡscore and extravascular lung water index(r=0.928,0.818,both P<0.05),but negatively correlated with oxygenation index(r=-0.939,P<0.00).⑤Taking ultrasound score was 13 as cutoff values,the area under ROC curve for evaluating extravascular lung water in ARDS patients was 0.937,the sensitivity and specificity were 100%and 73.1%,respectively.Conclusion Pulmonary ultrasound can effectively assess the severity of pulmonary edema in ARDS patients,guide individualized
作者
孙晶晶
丁键
孙玉霞
姚玉龙
SUN Jingjing;DING Jian;SUN Yuxia;YAO Yulong(Department of Intensive Care Unit,NO.7 People’s Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200137,China)
出处
《临床超声医学杂志》
CSCD
2019年第9期668-672,共5页
Journal of Clinical Ultrasound in Medicine
基金
上海市卫健委卫生行业临床研究专项青年项目(2019yqn394)
上海市浦东新区卫生和计划生育委员会临床高原学科建设(PWYgy2018-01)
上海中医药大学附属第七人民医院人才培养项目(xx2017-13)
关键词
肺部超声
床旁
急性呼吸窘迫综合征
应用价值
Pulmonary ultrasound,bedside
Acute respiratory distress syndrome
Application value
