摘要
目的探讨肺部超声在急性呼吸窘迫综合征(ARDS)患者肺水肿评估以及指导肺部治疗的应用价值。方法将上海市第七人民医院重症医学科收治的60例ARDS患者随机分为肺部超声组和对照组,每组各30例。收集患者性别、年龄、病因,记录患者入科时及第7 d的相关数据:急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、序贯器官衰竭评分(SOFA)、白细胞计数(WBC)、C反应蛋白(CRP)、降钙素原(PCT)、血管外肺水指数、氧合指数、机械通气治疗时间,肺部超声组收集肺部超声评分,两组患者的7天好转率、重症加强治疗病房(ICU)住院时间、28天死亡率。研究肺部超声在评估患者病情危重程度、治疗过程、预测预后的价值,以及肺部超声评分与血管外肺水指数等的相关性。结果两组在治疗前的APACHEⅡ评分、SOFA评分、氧合指数、血管外肺水指数、WBC、CRP、PCT差异无统计学意义(P>0.05),治疗7 d后两组患者均有改善,肺部超声组改善更明显,机械通气时间更短(P<0.05)。肺部超声组患者7天好转率较对照组高,入住ICU时间较对照组缩短,28天死亡率较对照组低(P<0.05)。所有患者的血管外肺水指数与APACHEⅡ评分、SOFA评分均呈正相关,与氧合指数呈负相关。肺部超声评分与APACHEⅡ评分、SOFA评分、血管外肺水指数均呈正相关,与氧合指数呈负相关。结论肺部超声在ARDS患者中能有效评估患者的严重程度,指导ARDS患者的个体化治疗,预测患者预后,可作为ARDS患者的常规监测手段。
Objective To explore the value of pulmonary ultrasound in the evaluation of pulmonary edema and the guidance of pulmonary therapy in patients with acute respiratory distress syndrome(ARDS). Methods Sixty patients with ARDS admitted to the Department of Critical Medicine of Shanghai Seventh People’s Hospital were randomly divided into a lung ultrasound group and a control group, with 30 patients in each group. The gender, age and etiology of patients were collected, and the relevant data were recorded at the time of admission and on the 7 th day,including Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ) score, Sequential Organ Failure Assessment score(SOFA), white blood cell count(WBC), C-reactive protein(CRP), procalcitonin(PCT), extravascular pulmonary water index, oxygenation index, and mechanical ventilation treatment time. Pulmonary ultrasound score was collected in the pulmonary ultrasound group. The 7-day improvement rate, intensive care unit(ICU) hospitalization time and 28 day mortality rate of the two groups were also collected. The value of pulmonary ultrasound in evaluating the severity,treatment process and prognosis of patients, and the correlation between pulmonary ultrasound score and extravascular pulmonary water index were studied. Results There was no significant difference in APACHEⅡ score, SOFA score,oxygenation index, extravascular pulmonary water index, WBC, CRP or PCT between the two groups before and after treatment(all P>0.05). After 7 days of treatment, the two groups improved, and the pulmonary ultrasound group improved more significantly with more shorter mechanical ventilation time, higher 7-day improvement rate, shorter ICU hospitalization time, and lower 28-day mortality rate(all P<0.05). The extravascular pulmonary water index was positively correlated with APACHEⅡ score and SOFA score, and negatively correlated with oxygenation index. The pulmonary ultrasound score was positively correlated with APACHEⅡ, and SOFA score and extravascular pulmonary water index,a
作者
姚玉龙
孙玉霞
雷鸣
YAO Yulong;SUN Yuxia;LEI Ming(Department of Critical Medicine,Shanghai Seventh People’s Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 200137,P.R.China)
出处
《中国呼吸与危重监护杂志》
CAS
CSCD
北大核心
2020年第1期41-46,共6页
Chinese Journal of Respiratory and Critical Care Medicine
基金
上海市卫健委科研课题青年项目（20194Y0191）
浦东新区卫生系统领先人才培养计划（PWR12019-02）
上海中医药大学附属第七人民医院人才培养项目（QMX2019-01）
关键词
肺部超声
血管外肺水
急性呼吸窘迫综合征
Pulmonary ultrasound
Extravascular pulmonary water
Acute respiratory distress syndrome
