肺部超声对重症肺部感染患者肺通气的评估价值

Application of pulmonary ultrasound in evaluating pulmonary ventilation in patients with severe pulmonary infection

目的:探讨肺部超声评价重症肺部感染患者通气情况的应用价值。方法:选取88例重症肺部感染患者,采用半定量方法对肺部超声征象进行评分,以CT检查结果为金标准,分析肺部超声评分与患者肺通气的关系;同时分析存活和死亡患者临床资料、肺部超声评分的差异,以及肺部超声评分预测患者死亡的价值。结果:88例患者全肺超声评分平均为(18.50±2.12)分,全肺CT值平均为(-620.50±88.13)HU,不通气/低通气肺组织比例平均为(10.41±3.35)%,正常通气肺组织比例平均为(71.54±6.69)%,过度通气肺组织比例平均为(17.65±4.11)%;患者肺部超声评分与全肺CT值、不通气/低通气肺组织比例呈正相关(r=0.775、0.648,P<0.05),与正常通气肺组织比例、过度通气肺组织比例无明显相关性(r=-0.170、0.046,P>0.05);死亡组患者年龄、糖尿病比例、APACHEⅡ评分、肺泡-动脉氧分压差、机械通气治疗和肺部超声评分分别为(59.28±8.12)岁、44.83%、(22.19±2.40)分、(344.40±82.29)mmHg、72.41%和(20.20±1.72)分,明显高于存活组(P<0.05),而氧合指数为(104.42±21.18),明显低于存活组(P<0.05);Logistic回归分析结果显示:年龄、APACHEⅡ、肺部超声评分是重症肺部感染患者死亡的影响因素(OR=1.758、2.841、2.440,P<0.05);肺部超声评分预测重症肺部感染患者死亡的ROC曲线下面积为0.901(95%CI:0.836~0.966),截断值为20分,灵敏性和特异性分别为82.80%和84.70%。结论:肺部超声可以作为重症肺部感染患者肺通气的评估指标,同时其在预测患者预后方面有一定应用价值。

Objective To explore the value of pulmonary ultrasound in evaluating ventilation in patients with severe pulmonary infection.Methods The pulmonary ultrasonic signs of 88 patients with severe pulmonary infection were scored by semiquantitative method,and the CT results were taken as the gold standard to explore the relationship between pulmonary ultrasound score and pulmonary ventilation.Meanwhile,the differences between survivors and dead patients in clinical data and pulmonary ultrasound score were analyzed,and the value of pulmonary ultrasound score in predicting death was assessed.Results The average pulmonary ultrasound score of 88 patients was 18.50±2.12,and their average lung CT value was(-620.50±88.13) HU.Moreover,the average proportions of no ventilation/hypoventilation,normal ventilation and hyperventilation lung tissues in the 88 patients were(10.41±3.35)%,(71.54±6.69)% and(17.65±4.11)%,respectively.The pulmonary ultrasound score was positively correlated with the whole lung CT value and the proportion of no ventilate/hypoventilation lung tissues(r=0.775,0.648;P<0.05),but had no significant correlation with the proportions of normal ventilation lung tissues and hyperventilation lung tissues(r=-0.170,0.046;P>0.05).In death group,the age,diabetes rate,APACHE Ⅱ score,alveolar-arterial partial oxygen pressure,percentage of mechanical ventilation and pulmonary ultrasound score were(59.28±8.12) years old,44.83%,22.19±2.40,(344.40±82.29) mmHg,72.41% and 20.20±1.72,respectively,which were significantly higher than those of survival group(P<0.05),but the oxygenation index was 104.42±21.18,significantly lower than that of survival group(P<0.05).The results of Logistic regression analysis revealed that age,APACHE Ⅱ and pulmonary ultrasound score were the influential factors of death in patients with severe pulmonary infection(OR=1.758,2.841,2.440;P<0.05).The area under the ROC curve of pulmonary ultrasound score for predicting death of patients with severe pulmonary infection was 0.901(95%CI:0.866-0.966),and the cut-off value was 20,and the sensitivity and specificity were 82.80% and 84.70%,respectively.Conclusion Pulmonary ultrasound can be used as an evaluation index of pulmonary ventilation in patients with severe pulmonary infection,and it has certain application value in predicting patient prognosis.