多目标联合超声在老年危重患者急性呼吸困难病因诊断中的应用

Application of multi-objective combined ultrasound in the diagnosis of acute dyspnea in elderly critical patients

目的探讨肺-心-下腔静脉-下肢深静脉(LCIDV)多目标联合超声在老年危重患者急性呼吸困难的病因诊断中的应用价值。方法选因急性呼吸困难入住南昌大学第二附属医院重症医学科、年龄≥65岁的呼吸衰竭患者,在常规诊疗的同时应用LCIDV多目标联合超声初步判断病因,记录初步诊断时间、初始诊断准确率、对主要病因诊断的准确率。结果220例患者纳入本研究,平均年龄(75±7)岁,LCIDV多目标联合超声对病因的初步诊断时间(18±3)min,初始诊断准确率92.9%。对急性呼吸窘迫综合征诊断的敏感性88.2%、特异性98.5%,心源性肺水肿的敏感性94.4%、特异性93.2%,肺炎的敏感性91.6%、特异性92.9%,慢性阻塞性肺疾病的敏感性95.0%、特异性100%,胸腔积液的敏感性100%、特异性99.5%。结论对因急性呼吸困难入住ICU的老年呼吸衰竭患者,LCIDV多目标联合超声对病因的初步诊断所需时间较短,诊断准确率高,值得临床推广。

Objective To explore the value of lung-cardiac-inferior vena cava-deep vein of lower extremity(LCIDV)integrated ultrasound in the etiological diagnosis of acute dyspnea in the elderly critically ill patients.Methods Patients with respiratory failure who were admitted to the Department of intensive care unit(ICU)of the Second Affiliated Hospital of Nanchang University due to acute dyspnea and aged over 65 years old were selected.At the same time of routine diagnosis and treatment,LCIDV integrated ultrasound was used to preliminarily determine the cause of the disease,and the time of initial diagnosis,the accuracy rate of initial diagnosis and the accuracy rate of main cause of the disease were recorded.Results 220 patients were included in this study.The average age was(75±7)years old.The initial diagnosis time of LCIDV integrated ultrasound was(18±3)min,and the accuracy of initial diagnosis was 92.9%.The sensitivity for the diagnosis of acute respiratory distress syndrome was 88.2%,the specificity was 98.5%,the sensitivity for cardiogenic pulmonary edema was 94.4%,the specificity was 93.2%,the sensitivity for pneumonia was 91.6%,the specificity was 92.9%,the sensitivity for chronic obstructive pulmonary disease was 95.0%,the specificity was 100%,the sensitivity for pleural effusion was 100%,the specificity was 99.5%.Conclusion For the elderly patients with respiratory failure who are admitted to ICU because of acute dyspnea,the initial diagnosis time of LCIDV integrated ultrasound is short,and the accuracy of diagnosis is high,which is worthy of clinical promotion.