重症新型冠状病毒肺炎临床和肺部超声影像特点

Clinical and lung ultrasound imaging features of severe coronavirus disease 2019

目的探讨重症新型冠状病毒肺炎(简称“新冠肺炎”)肺部超声影像学特征,为临床诊治提供参考。方法选择广州市第八人民医院ICU收治的29例重症新冠肺炎患者,其中重型15例,危重型14例,入ICU 24 h内进行肺部超声评分(LUS),同时收集患者性别、年龄、氧合指数(OI)和病程,计算临床肺部感染评分(CPIS)(由体温、OI、胸部X线片或CT、气道分泌物、白细胞计数组成)。结果29例患者中男性23例(79.3%),年龄(62.59±11.91)岁,LUS(19.28±4.96)分,OI(184.24±66.18)mmHg(1 mmHg=0.133 kPa),CPIS 4(3,4)分,病程(12.48±5.34)d,其中LUS与OI呈显著负相关(r=-0.742,P=0.000),与CPIS呈显著正相关(r=0.504,P=0.005)。危重型患者的LUS及CPIS明显高于重型患者,OI则明显降低,差异均有统计学意义(P<0.05),两组间性别、年龄和病程比较差异无统计学意义(P>0.05)。348个肺部超声检查区域中主要表现为B2征象,危重型与重型患者比较,N征象明显减少(9.5%vs 23.3%),C征象明显增多(17.3%vs 4.4%),病变区域比例明显增加(90.5%vs 76.7%),差异均有统计学意义(P<0.01);前区、侧区、后区肺部病变区域依次增加(63.8%,87.9%,98.3%),相互比较差异均有统计学意义(P<0.01);左肺与右肺超声征象分布和病变区域比较差异无统计学意义(P>0.05)。结论肺部超声能床旁实时评估重症新冠肺炎患者肺部病变性质、范围,为重症患者的诊断和治疗提供重要参考依据。

Objective To study the features of lung ultrasound imaging of severe coronavirus disease 2019(COVID-19),and provide reference for clinical diagnosis and treatment.Methods Twentynine patients with severe COVID-19 admitted to ICU of our hospital were enrolled,15 cases with severe and 14 cases with critical COVID-19.Pulmonary ultrasound examination and scoring were performed within 24 hours after admission to ICU by one specialized observer,the clinical information including gender,age,oxygenation index(OI)and disease course of all patients were collected by another observer,and clinical pulmonary infection score(CPIS)was calculated with body temperature,OI,chest X-ray or CT,airway secretions,and white blood cell count.Results 29 patients'clinical information include:male 23 cases(79.3%),age(62.59±11.91)years,LUS(19.28±4.96)points,OI(184.24±66.18)mmHg,CPIS 4(3-4)points),and disease course(12.48±5.34)days.LUS was negatively correlated with OI(r=-0.742,P=0.000)and positively correlated with CPIS(r=0.516,P=0.000).LUS and CPIS of critically ill patients were significantly higher than those of severe patients(P<0.05),and OI was significantly lower(P<0.05).There were no statistically significant differences in gender,age and disease course between the two groups(P>0.05).Among the 348 pulmonary ultrasound examination regions,the major manifestations were B2 signs.Compared with the severe patients,critically ill patientshad less N signs(9.5%vs 23.3%,P<0.01),more C signs(17.3%vs 4.4%,P<0.01),and more proportion of lesion areas was(90.5%vs 76.7%,P<0.01).The pulmonary lesion areas in the anterior,lateral and posterior regions were 63.8%,87.9%and 98.3%,showing statistical differences(P<0.01).There was no statistical difference in the distribution of ultrasonic signs and lesion areas between the left lung and the right one(P>0.05).Conclusion Pulmonary ultrasound can be used to assess pulmonary lesions for their characteristics and scopesin patients with severe COVID-19 at the point of care and can provide an important reference for the diagnosis and treatment of severe COVID-19 patients.