肺部超声评分与重症肺炎患者病情进展的相关性

Correlation between lung ultrasound score and disease progression in patients with severe pneumonia

目的探讨肺部超声评分(LUS)与不同程度重症肺炎患者病情进展的相关性。方法选取189例重症肺炎患者为研究对象,根据急性生理与慢性健康(APACHEⅡ)评分分为非危重症组(53例)、危重症组(86例)及极危重症组(50例),随访3个月,比较各组LUS、临床肺部感染评分(CPIS)、序贯器官衰竭评分(SOFA)、氧合指数(OI)、肺泡-动脉氧分压差(A-aDO2)、机械通气时间的差异;根据LUS是否>16分将患者分为低LUS组108例和高LUS组81例,比较两组上述参数的差异。应用Pearson相关分析法分析LUS与CPIS、SOFA、OI、A-aDO2、机械通气时间的相关性。结果极危重症组LUS(21.38±6.84)分、CPIS(8.02±2.43)分、SOFA(6.72±2.24)分,均高于危重症组[(19.15±6.23)分、(7.21±2.16)分、(5.93±2.11)分]和非危重症组[(14.26±4.72)分、(6.58±2.07)分、(5.18±2.06分)],且危重症组高于非危重症组(均P<0.05)。极危重症组OI(103.27±41.36)mm Hg(1 mm Hg=0.133 kPa)低于危重症组(131.45±52.41)mm Hg和非危重组(157.53±60.52)mm Hg,且危重症组低于非危重症组(均P<0.05);极危重症组A-aDO2和机械通气时间分别为(350.16±137.23)mm Hg、(7.02±1.45)d,均高于危重症组[(306.24±125.84)mm Hg、(6.23±1.36)d]和非危重症组[(238.47±107.16)mm Hg、(5.34±1.27)d],且危重症组高于非危重症组(均P<0.05)。高LUS组CPIS(8.00±2.33)分、SOFA(6.79±1.41)分,均高于低LUS组(6.68±2.11)分、(5.74±1.32分),差异均有统计学意义(均P<0.05)。高LUS组OI(106.08±43.21)mm Hg低于低LUS组(150.23±58.17)mm Hg,A-aDO2和机械通气时间[(363.78±141.39)mm Hg、(6.76±1.40)d]均高于低LUS组[(250.16±110.28)mm Hg、(5.76±1.33)d],差异均有统计学意义(均P<0.05)。Pearson相关分析显示,LUS与CPIS、SOFA、A-aDO2、机械通气时间均呈正相关(r=0.587、0.591、0.651、0.321,P=0.002、0.003、0.000、0.041),与OI呈负相关(r=-0.753,P=0.000)。结论LUS与重症肺炎患者病情严重程度具有一定相关性,对临床评估肺炎疗效有一定指导价值。

Objective To explore the correlation of lung ultrasound score(LUS)and the progression of severe pneumonia patients with different severity.Methods A total of 189 patients with severe pneumonia were selected,they were divided into non-critically ill group(53 cases),critically ill group(86 cases),very critically ill group(50 cases)according to the acute physiology and chronic health(APACHEⅡ)score.All patients in each group was followed up for 3 months,and the LUS,clinical pulmonary infection score(CPIS),trans-organ failure score(SOFA),oxygenation index(OI),alveolar-arterial oxygen partial pressure difference(A-aDO2),and mechanical ventilation time among the groups were compared.The patients were divided into low LUS group(108 cases)and high LUS group(81 cases)according to whether LUS>16,and the differences of above parameters were compared between the two groups.The correlation between LUS and CPIS,SOFA,OI,A-aDO2,mechanical ventilation time was analyzed by Pearson correlation analysis.Results The LUS,CPIS and SOFA of very critically ill group were(21.38±6.84)points,(8.02±2.43)points,(6.72±2.24)points,which were higher than those of critically ill group[(19.15±6.23)points,(7.21±2.16)points,(5.93±2.11)points]and non-critically ill group[(14.26±4.72)points,(6.58±2.07)points,(5.18±2.06)points].And the parameters of critically ill group were higher than those of non-critically ill group(all P<0.05).The OI of very critically ill group was(103.27±41.36)mm Hg(1 mm Hg=0.133 kPa),which was lower than that of critically ill group(131.45±52.41)mm Hg and non-critical ill group(157.53±60.52)mm Hg,and the parameter of critically ill group was lower than that of non-critically ill group(all P<0.05).The A-aDO2 and mechanical ventilation time of very critically ill group were(350.16±137.23)mm Hg and(7.02±1.45)d,which were higher than those of critical group[(306.24±125.84)mm Hg,(6.23±1.36)d]and non-critical group[(238.47±107.16)mm Hg,(5.34±1.27)d],and the parameters of critically ill group were higher than those of the non-critically ill group(all P<0.05).The scores of CPIS and SOFA of high LUS group were(8.00±2.33)points and(6.79±1.41)points,which were higher than those of low LUS group[(6.68±2.11)points,(5.74±1.32)points],the differences were statistically significant(both P<0.05).The OI of high LUS group was(106.08±43.21)mm Hg,which was lower than that of low LUS group(150.23±58.17)mm Hg.The A-aDO2 and mechanical ventilation time of high LUS group were(363.78±141.39)mm Hg and(6.76±1.40)d,which were higher than those of low LUS group[(250.16±110.28)mm Hg,(5.76±1.33)d],the differences were statistically significant(all P<0.05).Pearson correlation analysis showed that LUS was positively correlated with CPIS,SOFA,A-aDO2 and mechanical ventilation time(r=0.587,0.591,0.651,0.321,P=0.002,0.003,0.000,0.041),but negatively correlated with OI(r=-0.753,P=0.000).Conclusion LUS score is correlated with the severity of patients with severe pneumonia,which has a certain guiding value for clinical evaluation of curative effect of pneumonia.