床旁超声与床旁X线在呼吸机相关性肺炎早期诊断中的应用比较

Comparison of the application of bedside ultrasound and bedside X-ray in the early diagnosis of VAP

目的比较床旁超声与床旁X线在呼吸机相关性肺炎(VAP)诊断中不同时间段的阳性率,分析其时效性,找到更为合适的用于诊断VAP的影像学方法。方法前瞻性对我院重症监护室(ICU)行气管插管呼吸机辅助呼吸或控制呼吸治疗,且怀疑VAP的患者在怀疑VAP的当天、第三天和第五天同时进行床旁肺部超声(LUS)和床旁胸部X线检查,评估和比较上述两种检查方法在第一天、第三天和第五天检出VAP的准确率。结果本研究共纳入48例VAP患者。床旁LUS在第一天和第三天对VAP的检出率均显著高于床旁胸部X线检查(分别为:70.8%vs 39.6%,P=0.003;81.2%vs 66.7%,P=0.049),而两者在第五天对VAP的检出率差异无显著性(85.4%vs 83.3%,P=1.000)。结论床旁LUS在VAP早期的诊断过程中较床旁X线的阳性率更高,且床旁超声具有可重复、廉价、安全的优势。监护室中开展床旁LUS检查可以提高VAP的早期诊断率,给予及时、有效的抗生素治疗。

Objective To compare the positive rate of bedside ultrasound and bedside X-rays in the diagnosis of ventilator-related pneumonia(VAP) at different periods, and analyze the timeliness to find a more suitable imaging method for the diagnosis of VAP. Methods Patients who underwent endotracheal intubation ventilator-assisted or controlled respiratory therapy and developed a suspicion of VAP in the intensive care unit(ICU) of our hospital were prospectively performed bedside lung ultrasound(LUS) and bedside chest X-ray examination on the first, third, and fifth days. The accuracy of the two different methods was evaluated and compared on the first, third, and fifth days after VAP diagnosis. Results A total of 48 patients with VAP were included in this study. The detection rate of VAP by bedside LUS was significantly higher than that by bedside chest X-ray examination on the first day and third day(70.8 % vs 39.6 %, P=0.003,81.2 % vs 66.7 %, P=0.049, respectively), while there was no significant difference on the fifth day(85.4 % vs 83.3 %, P=1). Conclusion Bedside LUS demonstrates a higher positive rate than bedside X-rays for the early diagnosis of VAP, and bedside LUS is repeatability, inexpensive and safe. Conducting bedside LUS in ICU can improve the early diagnosis rate of VAP and give timely and effective antibiotic treatment.