肺部超声、机械功与重症肺炎肺水肿及ARDS关系分析

Analysis of the Relationship between Lung Ultrasound,Mechanical Work and Severe Pneumonia,Pulmonary Edema and ARDS

回顾性选取95例重症肺炎(SP)患者,根据是否发生急性呼吸窘迫综合征(ARDS)分为ARDS组(n=38)、无ARDS组(n=57),比较两组治疗前、治疗24 h后、治疗48 h后肺部超声评分(LUS)、机械功(MP),比较不同LUS评分、MP水平者肺水肿发生率,采用Spearman分析LUS评分、MP与ARDS严重程度关系,采用多因素Logistic回归方程分析ARDS的相关影响因素,采用受试者操作特征(ROC)曲线及ROC曲线下面积(AUC)分析各指标的预测价值。结果显示,ARDS组治疗24 h、48 h后LUS评分、MP高于无ARDS组(P<0.05);LUS评分、MP高水平者肺水肿发生率高于低水平者(P<0.05);治疗24 h、48 h后LUS评分、MP与ARDS发病及其严重程度呈正相关(P<0.05);治疗24 h、48 h后LUS评分联合MP预测ARDS的AUC分别为0.874、0.915(P<0.05)。提示LUS评分、MP有助于反映SP患者肺水肿发生风险,联合上述指标可为临床预测ARDS提供参考。

A retrospective selection of 95 patients with severe pneumonia(SP)admitted to our hospital was divided into ARDS group(n=38)and ARDS-free group(n=57)according to whether acute respiratory distress syndrome(ARDS)occurred,and the treatments of the two groups were compared.Lung ultrasound score(LUS)and mechanical function(MP)before,24 hours after treatment,and 48 hours after treatment,compare the incidence of pulmonary edema in patients with different LUS scores and MP levels,and use Spearman to analyze the relationship between LUS score,MP and the severity of ARDS.The multi-factor Logistic regression equation was used to analyze the relevant influencing factors of ARDS,and the receiver operating characteristic curve(ROC)and the area under the ROC(AUC)were used to analyze the predictive value of each index.The results showed that the LUS score and MP of the ARDS group were higher than those of the no ARDS group after 24 hours and 48 hours of treatment(P<0.05);the incidence of pulmonary edema in patients with high LUS score and MP was higher than that in patients with low levels(P<0.05);treatment after 24 h and 48 h,LUS score and MP were positively correlated with the incidence and severity of ARDS(P<0.05);after 24 h and 48 h of treatment,LUS score combined with MP predicted the AUC of ARDS to be 0.874 and 0.915,respectively(P<0.05).It is suggested that LUS score and MP help reflect the risk of pulmonary edema in SP patients,and the combination of the above indicators can provide references for clinical prediction of ARDS.