床旁心肺超声在心力衰竭合并肺水肿患者中的应用

Application of bedside cardiopulmonary ultrasound in patients with heart failure and pulmonary edema

目的探讨床旁心肺超声对心力衰竭合并肺水肿患者的临床应用。方法选取本院重症监护室或急诊病房2019年5月至2020年8月间收治的充血性心力衰竭的患者40例,对所有患者均进行床旁心肺超声的检查。结果对心力衰竭(NYHA)心功能在Ⅱ级以上心力衰竭的患者进行超声肺水肿评分检测,所有患者均涉及双侧弥漫性B线。患者的平均检查时间为(3.0±0.3)min。7分区法B线评分的中位数为11分;对心力衰竭(NYHA)心功能在Ⅱ级以上心衰患者利用超声对肺水肿评分进行诊断,其诊断值为12.4,此值下的灵敏性可以达到80.78%,特异度为60.24%;使用多因素回归分析显示,在心衰患者合并肺水肿的危险因素中,其中较为独立的危险因素包括平均E/e'、SPAP、NT-proBNP。结论床旁肺部超声目前是临床上对心衰肺水肿患者进行评估的一种有效手段,同时其具有操作方法较为简单且评估速度相对较快的优势。所以说肺部超声可成为临床上对心力衰竭合并肺水肿快速预测和评估预后的一个重要指标。

Objective To explore the clinical application of bedside cardiopulmonary ultrasound in patients with heart failure and pulmonary edema.Methods Forty patients with congestive heart failure admitted to the intensive care unit or emergency ward of our hospital between May 2019 and August 2020 were selected.All patients were examined by bedside cardiopulmonary ultrasound.Results The ultrasound pulmonary edema score was tested for patients with heart failure(NYHA)with heart function above gradeⅡ.All patients were involved in bilateral diffuse B lines.The average examination time for patients was(3.0±0.3)min.The median of the B-line score of the 7-zone method was 11 points.The pulmonary edema score of heart failure(NYHA)patients with heart function above grade Ⅱ was diagnosed by ultrasound.It was found that the diagnostic value was 12.4.The sensitivity under this value could reach 80.78%,and the specificity was 60.24%.Multivariate regression analysis showed that among the risk factors of heart failure patients with pulmonary edema,the independent risk factors included average E/e',SPAP,NT-proBNP.Conclusion Bedside pulmonary ultrasound is currently an effective method for clinical evaluation of patients with heart failure and pulmonary edema.At the same time,it has the advantages of simple operation method and relatively fast evaluation speed.Therefore,pulmonary ultrasound can become an important index for clinical rapid prediction and prognosis assessment of heart failure complicated with pulmonary edema.