床旁超声检查评估急性呼吸衰竭病因的临床应用

Clinical application of bedside ultrasound to assess the cause of acute respiratory failure

目的比较床旁心、肺联合超声检查与常规检查诊断急性呼吸衰竭病因的准确率和诊断价值。方法收集复旦大学附属中山医院2014年1月-2015年6月因急性呼吸衰竭收入ICU的成年患者。分别经常规检查(询问病史、体格检查和胸部X线摄片检查)和床旁心、肺联合超声检查得出病因诊断,比较两者诊断急性呼吸衰竭病因的准确率,并通过描绘ROC曲线评价两者在急性呼吸衰竭病因方面的诊断价值。结果 109例患者入组,其中肺相关因素占45.9%(50/109),心脏相关因素占17.4%(19/109),感染相关因素占18.3%(20/109),其他因素(反流误吸、呼吸肌神经肌肉病变)占18.3%(20/109)。床旁超声检查诊断与最终诊断的符合率为84.4%(92/109),显著高于常规检查的65.1%(71/109,P=0.001)。床旁超声检查和常规检查在诊断急性呼吸衰竭为肺相关因素所致的AUC分别为0.928(P=0.027)和0.743(P=0.048),诊断为心脏相关因素所致的AUC分别为0.957(P=0.032)和0.814(P=0.066),诊断为感染相关因素所致的AUC分别为0.944(P=0.040)和0.789(P=0.070),诊断为其他因素所致的AUC分别为0.889(P=0.054)和0.750(P=0.074)。结论床旁超声检查诊断肺、心脏和感染相关因素所致的急性呼吸衰竭的特异度和敏感度均高于常规检查,床旁心、肺联合超声检查可提高急性呼吸衰竭病因诊断的准确率,诊断价值较高。

Objective To compare the accuracy and diagnostic value between bedside cardiothoracic ultrasound and routine clinical examination in patients with acute respiratory failure（ARF）.Methods Adult ARF patients admitted to intensive care unit（ICU）from January 2014 to June 2015 were collected in this study.The causes of ARF were obtained by routine examination（based on medical history,physical examination and chest Xray）and cardiothoracic ultrasound,respectively.The accuracy of the two methods in assessing ARF causes was compared.The diagnostic value was evaluated by receiver operating characteristic（ROC）curve analysis.Results A total of 109 patients were included in this study.Thoracic related cause accounted for 45.9% of all the ARF patients（50/109）,cardiac related cause accounted for 17.4%（19/109）,sepsis related cause accounted for18.3%（20/109）and other causes（aspiration and neuromuscular disease）was also 18.3%（20/109）.Diagnostic ratio of ultrasound was 84.4%（92/109）,which was significantly higher than that of routine examination（65.1%,71/109,P=0.001）.The ROC curve analysis showed greater diagnostic performance of ultrasound in cases of lung disease（ultrasound：area under curve／[AUC／]=0.928,P=0.027;routine examination：AUC=0.743,P=0.048）,cardiac disease（ultrasound：AUC=0.957,P=0.032;routine examination：AUC=0.814,P=0.066）,sepsis（ultrasound：AUC=0.944,P=0.040;routine examination：AUC=0.789,P=0.070）and other diseases（ultrasound：AUC=0.889,P =0.054;routine examination：AUC=0.750,P =0.074）.Conclusion The ultrasound approach has better sensitivity and specificity in diagnosis of ARF caused by lung,cardiac diseases and sepsis.Bedside cardiothoracic ultrasound can improve the diagnosis accuracy of ARF and has a good diagnostic value.