改良心肺超声方案对休克分型的鉴别诊断价值

The value of modified cardio-pulmonary ultrasound in differential diagnosis of shock types

目的探究改良心肺超声方案对休克分型的鉴别诊断价值。方法纳入128例符合休克诊断的患者,由两名经验丰富的医师分别采用FALLS方案和改良FALLS方案对患者进行床旁心肺超声检查并记录休克分型诊断。以最终临床诊断(包括体征、临床表现、血流动力学监测、影像学检查、实验室检查以及最终治疗后反馈等)的休克分型为标准,对比两种心肺超声方案对休克分型的鉴别诊断价值。结果改良FALLS方案对梗阻性休克、心源性休克、低血容量性休克和分布性休克的诊断准确率均高于FALLS方案(98.4%vs.88.3%、89.8%vs.85.2%、96.9%vs.95.3%、86.7%vs.76.6%),改良FALLS方案与金标准一致性良好(Kappa=0.783,P<0.001),优于FALLS方案(Kappa=0.616,P<0.001)。FALLS方案和改良FALLS方案具有中等一致性(Kappa=0.706,P<0.001)。FALLS方案和改良FALLS方案花费时间对比差异无统计学意义(P>0.05)。结论引入下腔静脉(IVC)和左室充盈压(E/e’)指标的改良FALLS方案对休克分型的鉴别诊断价值更高,且不花费额外的超声操作时间。

Objective To explore the value of modified cardio-pulmonary ultrasound in differential diagnosis of shock types.Methods 128 patients with shock were enrolled.Two experienced doctors performed bedside cardio-pulmonary ultrasonography with FALLS protocol and modified FALLS protocol respectively,and recorded the diagnosis of shock types.The final clinical diagnosis was used as the standard of shock types(including signs,clinical manifestations,hemodynamic monitoring,imaging examination,laboratory examination and feedback after final treatment).To compare the diagnostic value of two cardio-pulmonary ultrasound protocol for shock types.Results The diagnostic accuracy of modified FALLS protocol in obstructive shock,cardiogenic shock,hypovolemic shock and distributed shock was higher than that of FALLS protocol(98.4%vs.88.3%、89.8%vs.85.2%、96.9%vs.95.3%、86.7%vs.76.6%).The modified FALLS protocol is in good consistency with the gold standard (Kappa=0.783,P<0.001),which is superior to the FALLS protocol(Kappa=0.616,P<0.001).There was moderate consistency between FALLS protocol and modified FALLS protocol (Kappa=0.706,P<0.001).There was no significant difference in the time spent between FALLS protocol and modified FALLS protocol(P>0.05).Conclusions The modified FALLS protocol which introduces the ultrasound index of inferior vena cava(IVC)and left ventricular filling pressure(E/e’)is of higher value in the differential diagnosis of shock typing and does not cost extra ultrasonic operation time.