肺部超声指导危重症患者肺部病变诊疗的效果评价

Evaluation on effect of lung ultrasound guiding diagnosis and treatment of lung lesions in critically ill patients

目的观察应用肺部超声评分(LUS)指导危重症患者肺部病变诊疗的效果.方法选择2017年9月至2019年10月北京大学人民医院重症监护病房(ICU)收治的ICU住院时间>2 d的212例危重症患者作为研究对象,按随机数字表法分为观察组和对照组,每组106例.观察组以LUS评分检查为主指导肺部病变诊疗;对照组常规应用床旁胸部X线或胸部CT指导肺部病变诊疗.观察两组患者的影像学检查应用情况、肺部物理及药物治疗情况,绘制Kaplan-Meier生存曲线,分析患者28 d累积生存情况.结果与对照组相比,观察组患者床旁胸部X线检查次数明显减少〔2(1,3)次比3(2,7)次,P<0.001〕,肺复张及胸腔积液引流更积极主动〔分别为6(2,10)次比5(2,8)次,17.92%(19/106)比7.55%(8/106),均P<0.05〕,根据影像学检查改变治疗策略的次数也增加〔3(2,5)次比2(1,3)次,P<0.001〕.106例行肺部超声检查的患者中,28 d内存活95例、死亡11例.随入组时间延长,死亡患者LUS评分呈逐渐升高趋势,存活患者LUS评分较稳定.观察组患者28 d累积生存率略高于对照组〔89.62%(95/106)比82.08%(87/106)〕,但差异无统计学意义.结论与床旁胸部X线相比,LUS评分对于评估长期住ICU的危重患者有明显优势,可以指导ICU医师及时调整针对肺部病变的诊疗措施,对改善患者预后有一定指导作用.

Objective To observe the effect of lung ultrasound score(LUS)guiding the diagnosis and treatment of lung lesions in critically ill patients.Methods A total of 212 critically ill patients admitted into the intensive care unit(ICU)of Peking University People's Hospital from September 2017 to October 2019 and staying in ICU for more than 2 days were selected as the research objects,and they were divided into an observation group and a control group according to the random number table method,with 106 cases in each group.In the observation group,the patients'diagnosis and treatment of pulmonary lesion were mainly guided by LUS score evaluation obtained by the examination of pulmonary ultrasound,while the patients in the control group were routinely examined by bedside chest X-ray or chest CT to guide the diagnosis and treatment of lung lesion.The application of imaging examination,lung physical situation and drug treatment of the two groups of patients were observed.Kaplan-Meier survival curve was drawn and the patients'28-day cumulative survival situation was analyzed.Results Compared with the control group,the number of bedside chest X-ray examination was significantly reduced[times:2(1,3)vs.3(2,7),P<0.001],lung re-expansion and pleural effusion drainage were more active[times:6(2,10)vs.5(2,8),17.92%(19/106)vs.7.55%(8/106),respectively,both P<0.05]in the observation group;the number of treatment strategy changes based on imaging examination was also increased[times:3(2,5)vs.2(1,3),P<0.001]in the observation group.Of the 106 patients who underwent pulmonary ultrasound examination,95 survived and 11 died within 28 days.From the enrollment date into the group,with the extension of time,the LUS score of patients with death outcome increased gradually,while that of the survival patients was stable.The 28-day cumulative survival rate of the observation group was slightly higher than that of the control group[89.62%(95/106)vs.82.08%(87/106)],but the difference was not statistically significant.Conclusion Compared with bedside chest X-ray,the pulmonary ultrasound LUS score has obvious superior advantages in evaluating critically ill patients staying in ICU for a long time.The score can guide ICU doctors to adjust the diagnosis and treatment measures for pulmonary lesions in time,and has a certain guiding role in improving the prognosis of the patients with pulmonary diseases.