急诊床旁肺部超声在诊断ICU术后低氧血症中的价值

The diagnostic value of bedside lung ultrasound in emergency for patients with postoperative hypoxemia in intensive care unit

目的探讨急诊床旁肺部超声(BLUE)对重症加强治疗病房(ICU)术后低氧血症患者的临床诊断价值.方法选择2017年4月至2018年10月在北京中日友好医院进修期间收治的ICU外科术后出现低氧血症患者50例,患者同时行胸部X线、BLUE和胸部CT检查,以胸部CT诊断结果为"金标准".统计3种诊断方法的敏感度、特异度、阳性预测值、阴性预测值及诊断准确率,并比较3种诊断方法的一致性.结果胸部CT检查显示,50例患者中有40例存在不同程度的气胸、胸腔积液、肺实变和肺不张.胸部X线诊断的敏感度为32.5%,特异度为60.0%,阳性预测值为76.47%,阴性预测值为18.18%,诊断准确率为38.0%;BLUE诊断的敏感度为80.0%,特异度度70.0%,阳性预测值为91.43%,阴性预测值为46.67%,诊断准确率为78.0%.一致性检验显示,胸部X线对术后低氧血症的诊断率明显低于胸部CT(Kappa=0.091,P=0.047)和BLUE(Kappa=0.107,P=0.031).BLUE对术后低氧血症的诊断率与胸部CT比较一致性较好(Kappa=0.634,P=0.000).结论BLUE对ICU外科术后低氧血症患者病因的诊断优于常规临床X线检查,较胸部CT更快捷、方便,值得临床推广应用.

Objective To explore the clinical diagnostic value of bedside lung ultrasound in emergency (BLUE) for patients with postoperative hypoxemia in intensive care unit (ICU). Methods Fifty patients with hypoxemia after ICU surgery postoperation were enrolled in Beijing China-Japan Friendship Hospital from April 2017 to October 2018, the chest X-ray, BLUE and chest CT examinations were performed at the same time, and the diagnostic result of chest CT was the gold standard. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate of the 3 methods in the diagnosis of hypoxemia were statistically analyzed, and the results of diagnostic consistency of 3 methods were compared. Results The chest CT findings showed there were 40 cases with different degrees of pneumothorax, pleural effusion, pulmonary consolidation and atelectasis in 50 patients. When the chest X ray was used to diagnose hypoxemia as the pathogenesis, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy rate were 32.5%, 60.0%, 76.47%, 18.18% and 38.0% respectively;the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy rate of BLUE were 80.0%, 70.0%, 91.43%, 46.67% and 78.0% respectively. The consistency test showed that the chest X-ray diagnosis rate of postoperation hypoxemia as the cause was significantly lower than that of chest CT (Kappa = 0.091, P = 0.047) and BLUE (Kappa =0.107, P = 0.031). The consistancy was relatively good when the diagnosis rate of postoperation hypoxemia obtained from BLUE regimen was compared with that obtained from chest CT (Kappa = 0.634, P = 0.000). Conclusion The use of BLUE for diagnosis of hypoxemia being the pathogenesis of the postoperative patients in ICU is superior to the use of routine chest X ray, and compared with applying chest CT, BLUE is faster, more convenient and worthy to be clinically applied widely.