床旁肺超声评估慢性阻塞性肺疾病急性加重合并肺炎的价值

Value of bedside lung ultrasound in the assessment of acute exacerbation of chronic obstructive pulmonary disease combined with pneumonia

目的探讨床旁肺超声评估慢性阻塞性肺疾病急性加重(AECOPD)合并肺炎的临床价值。方法对46例AECOPD合并肺炎患者行床旁肺超声检查,获得肺部超声B线数量,计算肺超声评分(LUS),分析LUS与氧合指数的相关性。绘制ROC曲线分析LUS和氧合指数对AECOPD合并肺炎的诊断效能。结果46例患者LUS为17.81±2.60,同一切面上见3条以上B线者33例;氧合指数(124.57±37.42)mm Hg(1mm Hg=0.133 kPa)。相关性分析显示,LUS与氧合指数呈负相关(r=-0.69,P<0.05)。ROC曲线分析显示,LUS截断值为20.63分时,其诊断AECOPD合并肺炎的敏感性90.8%,特异性87.3%,准确率89.1%,曲线下面积0.814;氧合指数截断值为139 mm Hg,其诊断AECOPD合并肺炎的敏感性87.2%,特异性83.3%,准确率85.6%,曲线下面积0.779。结论床旁肺超声能准确评估老年AECOPD合并肺炎患者的肺部情况,具有较好的临床应用价值。

Objective To investigate the value of bedside lung ultrasound in the assessment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)combined with pneumonia.Methods Forty-six patients with AECOPD combined with pneumonitis were selected,who underwent bedside lung ultrasound examinations.The number of B lines and lung ultrasound scores(LUS)were calculated in each patient,and the correlation between the LUS and the oxygenation index was analyzed.ROC curve was drawn to analyze the diagnostic efficacy of LUS and the oxygenation index for AECOPD with pneumonia.Results LUS of 46 patients was 17.81±2.60,and 33 cases were found to have more than 3 B-lines in the same section,the oxygenation index was(124.57±37.42)mm Hg(1 mm Hg=0.133 kPa).Correlation analysis showed that LUS was negatively correlated with oxygenation index(r=-0.69,P<0.05).ROC curve analysis shows that when the LUS cut-off value was 20.63,the sensitivity of diagnosing AECOPD combined with pneumonia was 90.8%,the specificity was 87.3%,the accuracy rate was 89.1%,and the area under the curve was 0.814.When the oxygenation index cut-off value was 139 mm Hg,the sensitivity of diagnosing AECOPD combined with pneumonia was 87.2%,the specificity was 83.3%,the accuracy was 85.6%,and the area under the curve was 0.779.Conclusion Bedside lung ultrasound can accurately assess the lung conditions of elderly patients with AECOPD combined with pneumonia,and has good clinical application value.