肺部超声评估ARDS患者病情严重程度及预后的应用价值

The application value of lung utrasonography in evaluating the severity and prognosis of the patients with ARDS

目的探讨肺部超声(LUS)在急性呼吸窘迫综合征(ARDS)患者中的病情评估及预后价值。方法采用前瞻性双盲队列研究,选取2016年7月至2018年1月宁波大学附属人民医院重症监护病房(ICU)符合柏林标准定义的ARDS患者33例,根据氧合指数(OI)将患者分为轻中度组(100 mmHg<OI≤300 mmHg)24例和重度组(OI≤100 mmHg)9例。所有患者入科第1天分别行胸部CT检查、LUS评分、经肺热稀释技术(TPTD)监测血管外肺水指数(EVLWI)。研究LUS评分与EVLWI、OI、LIS评分、APACHE-Ⅱ评分之间相关性,并探讨患者预后价值。结果与胸部CT对比,LUS诊断准确率为93.00%,敏感性为80.70%,特异性为97.20%,阴性预测值为93.60%,阳性预测值为90.80%;采用Pearson相关分析显示LUS评分与EVLWI呈高度正相关(r=0.840,P=0.001),与LIS评分呈高度正相关(r=0.634,P=0.001)、与APACHE-Ⅱ评分呈正相关(r=0.414,P=0.017),与OI呈负相关(r=-0.419,P=0.015)。ROC曲线分析LUS评分及EVLWI曲线下面积分别为0.933(P<0.05)、0.942(P<0.05),LUS评分为20.50分时阈值判断重度ARDS敏感性、特异性分别为88.90%、79.20%。结论肺部超声简单易行,LUS评分具有较高的效价,是一个更好的ARDS患者早期评估预后指标。

Objective To investigate the value of lung utrasonography(LUS)in evaluating the severity and prognosis of the patients with acute respiratory distress syndrome(ARDS).Methods A prospective double-blind cohort study was conducted.33 patients with ARDS in the intensive care unit(ICU)of Ningbo Yingzhou People's Hospital from July 2016 to January 2018 conforming to Berlin standard definition were selected.The patients were divided into the mild-moderate group(n=24)(100 mmHg<OI≤300 mmHg)and the severe group(n=9)(OI≤100)according to oxygenation index(OI).All the patients received chest CT,LUS scores and extravascular lung water index(EVLWI)monitored by the transpulmonary thermodilution(TPTD)technique on the first day of admission to the department.The correlations between LUS scores and EVLWI,OI,LIS scores and APACHE-Ⅱscores were studied,and the prognostic value for the patients was investigated.Results Compared with those of chest CT,the diagnostic accuracy rate of LUS was 93.00%,the sensitivity was 80.70%,the specificity was 97.20%,the negative predictive value was 93.60%,and the positive predictive value was 90.80%.Pearson correlation analysis showed that LUS score was significantly positively correlated with EVLWI(r=0.840,P=0.001)and LIS scores(r=0.634,P=0.001),obviously positively correlated with APACHE-Ⅱscores(r=0.414,P=0.017),and obviously negatively correlated with OI(r=-0.419,P=0.015).Receiver operating characteristic curve(ROC)analysis showed that the AUC of LUS score and EVLWI was 0.933(P<0.05)and 0.942(P<0.05),respectively,and the sensitivity and specificity of LUS score for severe ARDS were 88.90%and 79.20%,respectively when the LUS score of 20.50 was taken as threshold value.Conclusion LUS is simple and feasible.With high potency,LUS score constitutes a better indicator for early evaluation of prognosis for the patients with ARDS.