肺部超声监测对于ICU患者容量评估的应用价值

Application value of pulmonary ultrasound monitoring for capacity assessment of ICU patients

目的探讨肺部超声监测对于评估重症监护病房(ICU)患者容量变化情况,指导临床治疗。方法选取我院ICU收治的大手术后需要实施容量复苏的患者92例作为研究对象,根据患者预后结局分为生存组70例、死亡22例,对比两组患者ICU治疗前7d的肺脏超声B线数目、血管外肺水指数(EVLWI)、氧合指数、左室射血分数(LVEF)、氨基末端脑钠肽前体(NT-proBNP)、舒张早期血流峰值速度(E)/舒张晚期血流峰值速度(A),并分析B线数目与上述指标的关系。结果生存组患者的APACHEⅡ评分、呼吸机使用时间、ICU停留时间均低于死亡组患者,差异具有统计学意义(P<0.05);入住ICU第1d~第7d,生存组患者的肺脏超声B线数量均显著低于死亡组患者(P<0.05),生存组随着治疗时间延长,肺脏超声B线数量降低十分明显;入住ICU第1d、第3d,生存组患者的EVLWI、NT-proBNP、E/A值低于死亡组患者(P<0.05),氧合指数、LVEF测定值均高于死亡组(P<0.05);入住ICU第1d,92例患者患者的EVLWI、NT-proBNP、E/A值与B线数量呈显著的正相关(P<0.05),氧合指数、LVEF测定值与B线数量呈显著的负相关(P<0.05)。结论肺部超声监测对于评估ICU患者容量变化具有重要的价值,该项指标与患者心功能、血管外肺水水平具有较好的相关性。

Objective To explore the ultrasound monitoring of the lungs to assess the changes in the capacity of patients in the intensive care unit(ICU),in order to guide clinical treatment.Methods 92 patients with volume resuscitation after major surgery in our hospital were enrolled as the study subjects.According to the outcome of the patients,70 patients were in the survival group and 22 patients in the death group.The number of lung ultrasound B lines in the two groups before ICU treatment was compared,also including extravascular lung water index(EVLWI),oxygenation index,left ventricular ejection fraction(LVEF),amino terminal brain natriuretic peptide precursor(NT-proBNP),and peak diastolic blood flow velocity(E)/late diastolic blood flow Peak speed(A).The relationship of the number of B lines with the above indicators was analyzed.Results The APACHEⅡscore,ventilator use time,and ICU stay of the survival group were lower than those of the death group(P<0.05).The lung ultrasound B lines were obviously lower in the survival group than in the death group from the 1 st to the 7 th day of ICU,and the number of ultrasound B lines in the lungs decreased significantly with the treatment time prolonged.On the 1 st and 3 rd day of ICU,the value of EVLWI,NT-proBNP and E/A was lower in the survival group than in the death group(P<0.05),and the oxygenation index and LVEF were higher in the survival group than in the death group(P<0.05).On the 1 st day of ICU,the value of EVLWI,NT-proBNP and E/A was positively correlated with the number of B lines(P<0.05),and oxygenation index and LVEF were significantly negatively correlated with the number of B lines in 92 patients(P<0.05).Conclusion Ultrasound monitoring of the lungs has great value in assessing changes in the volume of patients in ICU,which shows a good correlation with cardiac function and extravascular lung water levels.