肺超声BLUE方案和ETUDES-plus方案在ICU呼吸困难患者中的应用价值

Application Value of Lung Ultrasound BLUE and ETUDES-plus in ICU Patients with Dyspnea

目的探讨肺超声BLUE方案和ETUDES-plus方案在ICU呼吸困难患者中的应用价值。方法选择2018年9月至2019年10月在黄山首康医院重症医学科(ICU)住院的94例患者为研究对象。所有患者入ICU后进行床旁超声BLUE方案和ETUDES-plus方案检查,以胸部CT作为诊断标准比较两种检查方案在呼吸困难患者病因诊断中的价值。结果以胸部CT作为诊断标准,ETUDES-plus方案病因诊断总正确率为97.87%(92/94),显著高于肺超声BLUE方案的84.04%(79/94),差异有统计学意义(χ^(2)=128.61,P<0.001)。ETUDES-plus方案在肺炎诊断上正确率为96.87%(31/32),显著高于BLUE方案的68.75%(22/32),差异有统计学意义(P=0.003);两种方案在充血性心力衰竭、AECOPD、气胸、支气管哮喘、ARDS、肺挫伤及其他诊断上差异无统计学意义(P>0.05)。肺超声BLUE方案和ETUDES-plus方案不同部位超声表现比较,A征象、平流层征最常见的部位是BLUE方案的上BLUE点和ETUDESplus方案的前胸壁上。胸腔积液、碎片征和组织样征最常见的部位是BLUE方案的PLAPS点和ETUDES-plus方案的背部下。结论ETUDES-plus方案在ICU呼吸困难患者病因诊断中有较高的正确率,值得临床应用。

Objective To explore the application value of lung ultrasound BLUE and ETUDES-plus in patients with dyspnea in ICU.Methods From September 2018 to October 2019,94 patients were admitted to the intensive care unit(ICU)of Shoukang Hospital in Huangshan City.All patients were examined by bedside ultrasound BLUE protocol and ETUDESplus protocol after admission to ICU.Chest CT was used as diagnostic criteria to compare the diagnostic value of these two protocols in dyspnea.Results The total correct rate of etiological diagnosis of ETUDES-plus was 97.87%(92/94),which was significantly higher than that of BLUE 84.04%(79/94).The difference was statistically significant(χ^(2)=128.61,P<0.001).The correct rate of ETUDES-plus was 96.87%(31/32),significantly higher than that of BLUE 68.75%(22/32),the difference was statistically significant(P=0.003).There was no significant difference between the two regimens in diagnosis of heart failure,AECOPD,pneumothorax,asthma,ARDS,pulmonary contusion and other diseases(P>0.05).The most common sites of A-sign and stratospheric sign were the upper BLUE site of BLUE and the anterior chest wall of ETUDES-plus.The most common sites of pleural effusion,debris and tissue-like signs were the PLAPS of BLUE and the lower back of ETUDESplus.Conclusion ETUDES-plus protocol has high accuracy in etiological diagnosis of dyspnea in ICU and is worthy of clinical application.