简化肺超声评分动态评估危重患者肺损伤的研究

Preliminary evaluation of simplified lung ultrasound score in dynamic assessment of lung injury in critically ill patients

目的探讨肺超声简化评分法在危重患者肺损伤动态评估中的应用价值.方法前瞻性观察2017年7月至8月浙江大学医学院附属第二医院急诊监护室收住的64例患者,应用经典的肺十二分区法进行超声评分,记录治疗过程中肺超声评分的动态变化,以及动脉血气分析、氧合指数、ICU住院时间等指标.在十二分区肺超声评分基础上,建立多种简化的肺超声评分法,观察与十二分区评分法的相关性.结果64例患者治疗前及治疗后简化四分区与十二分区相关性高(P<0.05).其中存活组治疗前及治疗后简化四分区与十二分区相关性高(P<0.05),治疗后简化四分区肺超声评分(3.11±0.95 vs.4.75±2.36,3.11±0.95,P<0.05)、氧合指数较治疗前改善(287.32±74.89 vs.355.12±61.07,P<0.05);存活组治疗前后各分区肺超声评分与氧合指数相关性较好(P<0.05).死亡组治疗前及治疗后简化四分区与十二分区相关性高(P<0.05),治疗后简化四分区肺超声评分(8.71±1.49 vs.5.71±1.79,P<0.05)、氧合指数(206.57±69.72 vs.117.42±28.56,P<0.05)较治疗前恶化;死亡组治疗前后各分区肺超声评分与氧合指数无相关性(P>0.05).脱机拔管前与拔管后9例患者简化四分区肺超声评分及氧合指数均改善(P<0.05).结论简化四分区肺超声评分法与经典十二分区法肺超声评分相关性高,同样反映危重患者肺损伤的程度,可以作为监护的评估手段应用于临床.

Objective To evaluate the value of simplified lung ultrasound score(LUS)in dynamic assessment of lung injury in critically ill patients.Methods Sixty-four patients admitted to the emergency intensive care unit(EICU)of the Second Affilited Hospital of Zhejiang University Medical College were prospectively observed from July 2017 to September.LUS in 12 regions was evaluated by ultrasound.LUS were recorded before and after treatment.The oxygenation index(PaO2/FiO2,PF),ICU hospitalization time and so on were recorded.Based on the 12 regions LUS,a variety of simplified LUS methods were established to observe the correlation with the 12 regions LUS.Results The correlation between the 4 regions and the 12 regions was high before and after the treatment of 64 atients(P<0.05).In the survival group,the simplified 4 regions before treatment and after treatment had a high correlation with the 12 regions(P<0.05).The simplified 4 regions LUS was improved after treatment(4.75±2.36 vs.3.11±0.95.P<0.05).PF was improved after treatment(287.32±74.89 vs.355.12±61.07,P<0.05).In death group,there was a good correlation between LUS and PF before and after treatment(P<0.05).Before and after treatment,the simplified 4 regions were highly correlated with the 12 regions in the death group(P<0.05).LUS deterioration in simplified 4 regions.Before treatment(5.71±1.79)compared with after treatment(8.71±1.49)(P<0.05).PF deteriorated.Before treatment(206.57±69.72)compared with after treatment(117.42±28.56)(P<0.05).There was no correlation between LUS and PF before and after treatment(P>0.05).The LUS and PF of the simplified 4 regions were improved in nine patients before and after extubation(P<0.05).Conclusion The simplified 4 regions LUS has a high correlation with the 12 regions LUS,which also reflects the degree of lung injury in critically ill patients and is worthy of clinical application as a means of monitoring.