肺超声胸部X线和CPIS评分对ICU重症肺炎患者肺实变的诊断价值分析

An Analysis of the Diagnostic Value of Lung Ultrasound Chest X-Ray and CPIS for Pulmonary Consolidation in ICU Patients with Severe Pneumonia

目的:探究床旁肺超声、胸部X线和临床肺部感染评分(CPIS)对重症肺炎患者肺实变的诊断价值。方法:纳入收治我院ICU的符合重症肺炎临床诊断标准的患者31例,采用床旁肺超声对患者双侧胸壁进行扫查,以肺超声特异性征象作为肺实变的诊断依据。并完善胸部X线、胸部CT检查及CPIS。以CT下特征性影像学表现作为诊断肺实变的“金标准”,评价肺超声、胸部X线和CPIS对肺实变的诊断价值。结果:31例患者中经CT检查确诊为肺实变共27例。肺超声诊断肺实变患者为26例,敏感度为92.6%,特异度75.0%,阳性预测值96.2%,阴性预测值60.0%,诊断准确率90.3%;胸部X线诊断肺实变患者为19例,敏感度为66.7%,特异度75.0%,阳性预测值94.7%,阴性预测值25.0%,诊断准确率67.7%;以CPIS≥6分诊断肺实变患者为21例,敏感度为70.4%,特异度50.0%,阳性预测值90.5%,阴性预测值20.0%,诊断准确率66.7%。一致性检验结果显示,肺超声与CT诊断具有较高的一致性(Kappa=0.611)。结论:肺超声、胸部X线和CPIS评分对肺实变有较高的诊断价值,肺超声诊断价值更优。

Objective:To explore the diagnostic value of bedside lung ultrasound,chest X-ray and clinical pulmonary infection score(CPIS)in pulmonary consolidation of patients with severe pneumonia.Methods:31 patients with severe pneumonia were included in ICU of our hospital.Bedside lung ultrasound was used to scan the bilateral chest wall of the patients,and the specific signs of lung ultrasound were used as the diagnostic basis of pulmonary consolidation.And the chest X-ray,chest CT and CPIS are improved.To evaluate the diagnostic value of pulmonary ultrasound,chest X-ray and CPIS in pulmonary consolidation,the"gold standard"of CT characteristic imaging is applied.Results:27 patients were diagnosed as pulmonary consolidation by CT.There were 26 cases of pulmonary consolidation in lung ultrasound,the sensitivity was 92.6%,the specificity was 75.0%,the positive predictive value was 96.2%,the negative predictive value was 60.0%,and the diagnostic accuracy was 90.3%;19 cases were diagnosed in chest X-ray examination,the sensitivity was 66.7%,the specificity was 75.0%,the positive predictive value was 94.7%,the negative predictive value was 25.0%,and the diagnostic accuracy was 67.7%;21 cases were diagnosed with CPIS≥6,with sensitivity of 70.4%,specificity of 50.0%,positive predictive value of 90.5%,negative predictive value of 20.0%,and diagnostic accuracy of 66.7%.The results of consistency test showed that there was a high consistency between pulmonary ultrasound and CT diagnosis(kappa=0.611).Conclusion:Lung ultrasound has a high diagnostic value for pulmonary consolidation.Ultrasound,chest X-ray and CPIS have certain diagnostic value for lung consolidation,and pulmonary ultrasound has better diagnostic value.