危急重症患者的肺超声检查

Lung ultrasound for critically ill patients

即时超声在床旁的应用日益广泛,能对危急重症患者的不同病况做出评价。肺超声征象是由超声伪像(气体-组织界面多重反射)及实际图像(如胸水、肺实变等)构成的,这些征象对辨别主要的肺疾病至关重要。单独的肺超声检查,或结合其他部位的超声检查,对诊断急性呼吸衰竭、循环休克及心脏骤停非常有帮助。此外,肺超声可在床旁进行肺充气的半定量测定,并可用于指导机械通气,评价治疗效果,监测呼吸状态,帮助脱机过程及引导插管定位。肺超声还可用于早期发现并处理机械通气状态下的并发症。本文对基本的肺超声征象及在危急重症患者中的应用作一综述。

Recently point-of-care ultrasound has been extensively used at bedside to aid evaluating various situations of critically ill patients.The sonographic signs of lung ultrasound are composed of artifacts(reverberation of interface between gas and the pleura)and real images(i.e.,pleural effusion,consolidation).These semiotics are essential to identify main pulmonary diseases.Lung ultrasound alone,or combined with other sonography helps to diagnose acute respiratory failure,circulation shock and cardiac arrest.Moreover,lung ultrasound can perform a semiquantification of lung aeration at the bedside and can be used to guide positive end-expiratory pressure setting,assess the efficacy of treatments,monitor the evolution of the respiratory disorder,help the weaning process,and position the tracheal intubation.Finally,lung ultrasound can be used for early detection and management of respiratory complications under mechanical ventilation.This review describes basic lung sonographic signs and focuses on their applications in critical care patients.