肺部超声对重症监护病房中新型冠状病毒肺炎的应用价值

Application of lung ultrasound in patients with new coronavirus pneumonia in intensive care unit

目的观察肺部超声在重症监护病房(ICU)接受治疗的新型冠状病毒肺炎(COVID-19)患者中的应用价值。方法回顾分析2020年2月20日至3月19日武汉雷神山医院B2病区ICU收治的50例COVID-19患者的临床资料。患者在入ICU时均接受肺部CT及肺部超声检查,记录相关数据:APACHEⅡ评分、C反应蛋白、白介素6、静态肺顺应性、氧合指数、肺部超声评分,并将CT与超声图像进行对比。记录患者入ICU后28 d内存活情况及存活患者的ICU住院天数。结果患者的肺部超声评分与APACHEⅡ评分、C反应蛋白、白介素6呈正相关,与静态肺顺应性、氧合指数呈负相关(P均<0.01);以肺部CT图像为金标准,肺部超声诊断肺部疾病的准确性为90.3%(542/600)、敏感度为87.1%(316/363)、特异度为95.3%(226/237);入ICU 28 d存活患者的肺部超声评分与ICU治疗时间呈正相关(P<0.01)。结论肺部超声应用在ICU治疗的COVID-19患者中,与肺部CT一致性高,能有效评估患者的严重程度、炎症状态、肺部顺应性及预测患者预后,可作为在ICU治疗的COVID-19患者的必要监测方法。

Objective To assess the application value of lung ultrasound in patients with new coronavirus pneumonia(COVID-19)treated in the intensive care unit(ICU).Methods A retrospective analysis was performed on the clinical data of 50 COVID-19 patients admitted to the B2 ICU of Wuhan Leishenshan Hospital from 20 February to 19 March 2020.Patients underwent lung CT and lung ultrasonography when they were admitted to ICU.APACHEⅡscore,C-reactive protein,interleukin-6,static lung compliance,oxygenation index,and lung ultrasound score were recorded.CT images were compared with ultrasound images.The patient's survival within 28 days after ICU admission and the ICU hospitalization days of the surviving patients were also recorded.Results The lung ultrasound scores of the patients were positively correlated with APACHEⅡscore,C-reactive protein,and interleukin-6,and negatively correlated with static lung compliance and oxygenation index(P<0.01).Taking lung CT images as the gold standard,the accuracy,sensitivity,and specificity of lung ultrasound for diagnosis of lung diseases were 90.3%(542/600),87.1%(316/363),and 95.3%(226/237),respectively.The lung ultrasound scores of patients who survived 28 days after ICU admission were positively correlated with the ICU treatment time(P<0.01).Conclusion Pulmonary ultrasound has high consistency with lung CT in COVID-19 patients treated in the ICU and can effectively assess the patient's severity,inflammation,and lung compliance and predict patient prognosis.It can be used as a useful monitoring method for patients with COVID-19 in the ICU.