床旁肺超声B线特征、下腔静脉内径与急性重症左心肢患者水潴留及疾病诊断的关系研究

Diagnostic vslue of combined pulmonary ultrasound,color Doppler ultrasound of inferior vena cava diameter,and water retention scoring in patients with heart failure

目的研究床旁肺超声B线特征、下腔静脉内径与急性重症心衰患者水潴留及疾病诊断的关系。方法选取2017年1月—2018年12月期间乐山市人民医院收治的90例呼吸困难患者为研究对象,其中急性重症心衰患者49例,非心衰患者41例。分别对患者进行床旁肺超声,下腔静脉超声以及水潴留积分评估,分析急性重症心衰组患者与非急性重症心衰组患者的基础资料、B线积分、下腔静脉(Inferior vena cava,IVC)以及水潴留积分之间的差异,评估B线积分、下腔静脉直径(Inferior vena cava diameter,IVCD)以及水潴留积分联合检测餉诊断效能。结果急性重症心衰组患者的心率、慢阻肺发病情况显著高于非急性重症心衰组,急性重症心衰组患者LVEF显著低于非急性重症心衰组,急性重症心衰组患者的B线积分、IVCD与水潴留积分显著高于非急性重症心衰组患者,联合检测的诊断效能显著高于单独检测,同时,针对患者的心衰情况,B^*线积分、下腔静脉内径与水潴留积分的临界值分别为11.95,1.79cm以及3.45。结论床旁肺超声B线特征JVCD内径与重症心衰患者水潴留呈现显著相关性,通过对患者的床旁肺超声B线特征、IVCD内径的测量,显著降低患者的水潴留积分评估中的偏倚,提升患者诊断灵敏度。

Objective To study the relationship among b-line characteristics of bedside pulmonary ultrasound,inferior vena cava diameter(IVCD),water retention and disease diagnosis in patients with severe heart failure.Methods Ninety demographically matched patients with dyspnea,49 with heart failure and 41 without heart failure,underwent bedside pulmonary ultrasound and doppler ultrasound of IVCD.Water retention score was assessed by auscultation of roles,and observation of jugular vein and lower extremity edema.The diagnostic efficacy of combined detection of bline integral,IVCD,and water retention integral was evaluated.Results The incidence rate of chronic obstructive pulmonary disease in the heart failure group was significantly higher than that in the non-heart failure group.The LVEF in the heart failure group was significantly lower than that in the non-heart failure group.The b-line integral,IVCD and water retention integral in the heart failure group were all significantly higher than those in the non-heart failure group.The diagnostic efficiency of combined detection was significantly higher than that of single detection.At the same time,the critical values of b-line integral,IVCD and water retention integral were significantly higher for the patients with heart failure.Conclusion Measuring the b-line characteristics of bedside pulmonary ultrasound and ivc inner diameter help reduce the bias in the evaluation of water retention and improve the diagnostic sensitivity,the diagnostic sensitivity of patients was improved.