床旁肺超声彗星尾征在急性心力衰竭诊断中的价值

The value of bedside ultrasound lung comets in the diagnosis of acute heart failure

目的探讨床旁肺超声彗星尾征(ULCs)在急性心力衰竭(AHF)患者中的应用价值。方法收集2016年5月~2017年5月重庆市人民医院(三院院区)急诊内科收治的AHF患者40例。所有患者在符合诊断后24 h内,由有经验的检查医师对患者分别进行床旁肺超声、胸部CT检查。统计肺超声评分与胸部CT评分的相关性、ULCs数目和超声心动图参数间[左心房内径(LA)、左室舒张末内径(LVEDD)、射血分数(EF)]的相关性、ULCs鉴别AHF的特异度和敏感度。结果患者肺超声评分为(16.43±4.31)分,胸部CT评分为(12.11±5.32)分,两者评分间具有显著的线性相关关系(r=0.561,P<0.01)。ULCs数目与LA、LVEDD呈正相关(r=0.331,P<0.01;r=0.325,P<0.01),与EF呈负相关(r=-0.378,P<0.01)。ULCs的ROC曲线下面积为0.933(95%CI:0.895,0.980)。当ULCs数目>5条时,诊断AHF的敏感度为90.2%(37/41),特异度为66.7%(6/9);当ULCs数目≥8条时,诊断AHF的敏感度下降为68.3%(28/41),特异度为88.9%(8/9);当ULCs数目≥20条时,诊断AHF的敏感性降到51.2%(21/41),特异性达到100.0%(9/9)。结论肺部超声检测ULCs是一种很好的评估判定AHF的方法,具有较高的敏感性、特异性,在AHF评估方面具有广泛的推广价值。

Objective To explore the application value of bedside ultrasound lung comets(ULCs) in the patients with acute heart failure(AHF). Methods Forty cases of patients with AHF admitted to the Department of Emergency of Chongqing General Hospital(the Third Branch) from May 2016 to May 2017 were collected. Within 24 hours of the diagnosis, all patients were examined by the experienced examiners respectively by bedside lung ultrasound and chest CT. The correlation between pulmonary ultrasonography scores and chest CT scoresis was determined, as well as the correlation between the number of ULCs and echocardiographic parameters [left atrial diameter(LA), left ventricular end-diastolic diameter(LVEDD), ejection fraction(EF)], and the specificity and sensitivity of patients with AHF were identified by ULCs. Results Pulmonary ultrasonic scores for patients were(16.43±4.31) scores, and the chest CT scores were(12.11±5.32) scores, there was a significant linear correlation between the two scores(r = 0.561, P<0.01). The number of ULCs was positively correlated with LA and LVEDD(r = 0.331, P<0.01;r = 0.325, P<0.01), and negatively correlated with EF(r =-0.378, P<0.01). The area under the ROC curve for ULCs was 0.933(95%CI: 0.895,0.980). When the number of ULCs was more than 5, the sensitivity to diagnose AHF was 90.2%(37/41) and the specificity was 66.7%(6/9);when the number of ULCs was more than 8, the sensitivity to diagnose AHF was reduced to68.3%(28/41) and the specificity was 88.9%(8/9);when the number of ULCs was greater than 20, the sensitivity of diagnosis of AHF was reduced to 51.2%(21/41) and specificity reached 100.0%(9/9). Conclusion Ultrasound lung de-tection of ULCs is a good method for evaluating and determining AHF. It has high sensitivity and specificity, and has broad application prospect in AHF assessment.