肺部超声评估急性呼吸窘迫综合征临床应用价值

Application of lung ultrasonography score on clinical evaluating in patients with acute respiratory distress syndrome

目的探讨肺部超声(lung utrasonography,LUS)在急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者早期病情评估中的应用价值。方法采用前瞻性双盲队列研究,选取2016年7月至2020年1月宁波市鄞州人民医院重症监护病房(ICU)符合柏林标准定义的ARDS患者,根据氧合指数(oxygenation index,OI)将患者分为轻中度组(100 mmHg<OI≤300 mmHg)和重度组(OI≤100 mmHg)。所有患者入科第一天分别行胸部CT检查、LUS评分、经肺热稀释技术(the transpulmonary thermodilution technique,TPTD)监测血管外肺水指数(extravascular lung water index,EVLWI),并同步记录APACHEⅡ评分、肺损伤评分(lung injury score,LIS)评分及氧合指数PaO2/FiO2(OI)。应用SPSS 18.0软件,计数资料比较采用χ2检验;计量资料组间比较采用独立样本t检验或单因素方差分析,采用Pearson线性相关分析LUS评分与EVLWI、OI、APACHEⅡ评分、LIS评分之间的相关性。为评估肺部超声诊断ARDS效能,建立受试者工作特征曲线(ROC)分析其评估ARDS严重程度价值。以P<0.05为差异有统计学意义。结果共纳入符合条件的ARDS患者52例,其中轻中度组34例,重度组18例。与胸部CT对比,LUS诊断准确率为93.12%、敏感度为91.33%、特异度为95.31%、阳性预测值为95.95%、阴性预测值为90.03%;相关分析显示LUS评分与EVLWI评分呈明显正相关(r=0.756,P<0.01)、与LIS评分呈明显正相关(r=0.817,P<0.01)、与APACHEⅡ评分呈正相关(r=0.655,P<0.01),与OI呈明显负相关(r=-0.823,P<0.01)。ROC曲线分析LUS评分及EVLWI曲线下面积(AUC)分别为0.922、0.972,以LUS评分19.50分作为截断值预测重度ARDS敏感度及特异度分别为0.833、0.791。结论肺部超声简单易行,LUS评分具有较高的效价,是早期评估ARDS患者预后的较好指标。

Objective To evaluate the value of lung ultrasound(LUS)in the early assessment of patients with acute respiratory distress syndrome(ARDS).Methods A prospective double-blind cohort study was conducted.Patients with ARDS conformed to the Berlin diagnosis criteria admitted to the Intensive Care Unit(ICU)of Ningbo Yinzhou People’s Hospital from July 2016 to January 2020.According to the oxygenation index(OI),the patients were divided into the mild to moderate group(100 mmHg<OI≤300 mmHg)and the severe group(OI≤100 mmHg);Patients underwent LUS and transpulmonary thermodilution technique(TPTD)monitoring and chest CT on the first day after diagnosis.Acute physiology and chronic health status(APACHEⅡ)score,lung injury score(LIS),and PaO2/FiO2(OI)were recorded at admission.LUS score,EVLWI,OI,APACHEⅡ score and LIS were compared.The correlation between LUS and EVLWI,OI,APACHEⅡ score and LIS score was measured by Pearson linear correlation anaysis.Receiver operating characteristic(ROC)curve were used to evaluate LUS score in predicting ARDS.Results A total of 52 patients with ARDS were enrolled,34 patients in the mild to moderate group and 18 patients in the severe group.Compared with chest CT scans,the accuracy of LUS diagnosis was 93.12%,the sensitivity was 91.33%,the specificity was 95.31%,the positive predictive value was 95.95%,and the negative predictive value was 90.03%.Pearson linear correlation analysis showed that LUS was positively correlatied with EVLWI(r=0.756,P<0.01),LIS score(r=0.817,P<0.01),and APACHEⅡscore(r=0.655,P<0.01),while was negatively correlated with OI(r=-0.823,P<0.01).The areas under the receiver operating characteristic curves of LUS and EVLWI measured by TPTD were 0.922(P<0.01)and 0.972(P<0.01),LUS score threshold value of 19.5 had the sensitivity of 0.833 and specificity of 0.791 for prediction of severe ARDS.Conclusions LUS is convenient and easy to perform,and LUS score has a high value,which is a better prognostic indicator for early assessment of ARDS patients.