肺部超声和床旁胸部X线检查在诊断老年社区获得性肺炎的对比性研究

Comparative study of the lung ultrasonography and bedside chest X-ray in the diagnosis of elderly community acquired pneumonia

目的:比较肺部超声是否和床旁胸部X线检查具有老年社区获得性肺炎(CAP)同样的诊断效力;比较肺部分区逐肋探查法和改良BLUE方案两种肺部超声探查方法在诊断老年CAP时是否具有同样的诊断效力。方法:2018年12月-2020年11月期间在北京中医药大学东直门医院急诊科就诊、符合65岁及以上社区来源疑似CAP临床特点的患者入选本研究,分别进行床旁胸部X线检查、床旁肺部超声检查和胸部CT检查。以胸部CT为金标准,统计床旁胸部X线和肺部超声诊断的阳性和阴性例数。结果:基于多种征象联合诊断老年CAP,肺部超声敏感度低于床旁胸部X线检查(78.3%vs.85.0%),特异度高于床旁胸部X线检查(91.3%vs.71.7%),而整体诊断准确率高于床旁胸部X线检查(84.0%vs.79.2%);基于多种征象联合诊断老年CAP,肺部分区逐肋探查法其敏感度、特异度、诊断准确率(78.3%、91.3%、84.0%)均高于改良BLUE方案(61.7%、89.1%、73.6%)。结论:肺部超声可作为相当于床旁胸部X线的一种有效诊断老年CAP的检查方法,达到急诊科医生早期、快速、准确诊断老年CAP的目的;改良BLUE方案不能够替代逐肋探查的超声检查方法诊断老年CAP。

Objective: To compare whether the lung ultrasonography has the same efficacy for the diagnosis of community acquired pneumonia(CAP) in the elderly with bedside chest X-ray;To compare whether two check methods, the rib-by-ribexploration and the Modified Bedside Lung Ultrasound Examination(M-BLUE) has the same efficacy in detection of CAP in the elderly. Methods: From December 2018 to November 2020, patients who reached 65 and presented to the Emergency Department, Dongzhimen Hospital, Beijing University of Chinese Medicine with suspected CAP clinical characteristics were included in this study. Each of the patients received bedside chest X-ray, bedside lung ultrasonography and chest Computed Tomography(CT). Using chest CT scan as the gold standard, the positive and negative cases diagnosed by bedside chest X-ray and lung ultrasonography were counted. Results: Based on multiple signs combined in diagnosis of CAP in the elderly, the sensitivity of lung ultrasonography is lower(78.3% vs. 85.0%), while its specificity(91.3% vs. 71.7%) and overall diagnostics accuracy(84.0% vs. 79.2%) were higher than the bedside chest X-ray. Based on multiple signs combined in diagnosis of CAP in the elderly, the sensitivity, specificity and overall diagnostics accuracy of rib-by-ribexploration(78.3%,91.3%,84.0%) were higher than the M-BLUE(61.7%,89.1%,73.6%). Conclusion: As bedside chest X-ray, the lung ultrasonography can serve as an effective method for diagnosis of CAP in the elderly, which can help doctors in emergency department diagnose CAP in the elderly timely, fast and accurately. The M-BLUE cannot replace rib-by-ribexploration in detection of CAP in the elderly.