肺部超声评估急性呼吸窘迫综合征血管外肺水的临床价值

Clinical value of extravascular lung water assessed by lung ultrasound in patients with acute respiratory distress syndrome

目的:探讨床旁肺部超声评分用于监测急性呼吸窘迫综合征(ARDS)血管外肺水(EVLW)的可行性及临床价值。方法:选取2015年1月至2016年12月广西壮族自治区人民医院重症医学科收治的ARDS患者40例,根据ARDS"柏林定义"诊断标准,按氧合指数(PaO_2/FiO_2)不同将ARDS患者分为轻、中、重度,分别于ARDS诊断第1、第3、第7天用床旁超声监测肺部评分,应用脉搏指示连续心排血量监测(PICCO)得到血管外肺水指数(EVLWI)。对比轻、中、重度ARDS患者肺部超声评分、EVLWI及PaO2/FiO2的差异,并对肺部超声评分与EVLWI、PaO_2/FiO_2的相关性进行分析。结果:轻、中、重度ARDS患者肺部超声评分、EVLWI、氧合指数比较,差异有统计学意义(均P<0.05)。Pearson相关分析结果显示,肺部超声评分与PaO_2/FiO_2呈负相关关系(r=-0.874,P<0.001),与EVLWI呈正相关关系(r=0.798,P<0.001)。结论:肺部超声评分是一种无创、便捷、经济、能有效评估ARDS患者EVLW的方法。

Objective：To investigate the clinical value and the feasibility of extravascular lung water （EV- LW） assessed by lung ultrasound score of bedside lung ultrasound on patients with acute respiratory dis- tress syndrome （ARDS）. Methods：40 patients with ARDS treated in our hospital from January 2015 to De- cember 2016 were selected and divided into mild, moderate and severe groups according to oxygenation in- dex （PaO2/FiO2） in the ＂Berlin definition＂ diagnostic criteria. Patients were assessed by bedside ultra- sound monitoring of lung scores and pulse index continuous cardiac output （PICCO） to obtain the EVLWI in the first day, the third day, and the seventh day after ARDS diagnosis. The lung ultrasound score, EV- LWI and PaO2/FiO2 were compared among groups, and their correlation was analyzed as well. Results： There were significant differences in lung ultrasound score, EVLWI and PaO2/FiO2 among three groups （P〈0.05）. Pearson correlation analysis showed that lung ultrasound score was negatively correlated with PaO2/FiO2（r=-0. 874, P〈0. 001）, and was positively associated with EVLWI （r-=0. 798, P〈0. 001）. Conclusion：Lung ultrasound score was an convenient, economical, and effective method for assessing EVL- WI in patients with ARDS.