肺超声定量联合血管外肺水指数在成人ARDS早期诊断中的应用研究

Application of quantitative pulmonary ultrasound combined with extravascular pulmonary water index for the early diagnosis of adult ARDS

目的分析肺超声定量联合血管外肺水指数(EVLWI)用于成人急性呼吸窘迫综合征(ARDS)早期诊断的临床价值。方法前瞻性选择高度怀疑ARDS患者共78例为研究对象,经确诊ARDS患者58例(观察组),非ARDS患者20例(对照组)。比较两组肺超声显示彗星尾征(即B线)数量和半定量评分、EVLWI,以及观察组患者治疗前后上述指标的变化。结果观察组治疗后B线数量、半定量评分和EVLWI值均明显低于治疗前,差异均有统计学意义(t分别=8.12、10.20、5.86,P均<0.05)。观察组B线数量、半定量评分和EVLWI值均明显高于对照组,差异有统计学意义(t分别=9.62、15.43、7.50,P均<0.05)。半定量评分和EVLWI值有较好的正相关性(r=0.45,P<0.05)。受试者工作特征曲线(ROC)显示,半定量评分联合EVLWI值诊断ARDS的曲线下面积为0.86,灵敏度为85.61%,特异度为74.34%,半定量评分临界值为12.34分,EVLWI临界值为2.76。结论肺超声联合脉搏指示连续心排血量监测(PiCCO)测量EVLWI在成人ARDS早期诊断中有较好的准确性。

Objective To analyze the value of quantitative pulmonary ultrasound combined with extravascular pulmo-nary water index(EVLWI)for the early diagnosis of adult acute respiratory distress syndrome(ARDS).Methods A to-tal of 78 patients with highly suspected ARDS were prospectively selected as the research objects.58 patients with ARDS(observation group)and 20 patients without ARDS(control group)were diagnosed by chest CT and oxygenation index.The number of comet tail sign(line B),semi quantitative score,and EVLWI were compared between the two groups,and the changes of above indexes in the observation group before and after treatment were compared.Results The number of line B,semi quantitative score and EVLWI in the observation group after treatment were significantly lower than those be-fore treatment(t=8.12,10.20,5.86,P<0.05).The number of line B,semi quantitative score,and EVLWI in the observa-tion group were significantly higher than those in the control group(t=9.62,15.43,7.50,P<0.05).The semi quantitative score was positively correlated with EVLWI(r=0.45,P<0.05).The ROC result showed that the area under the curve(AUC)of semi quantitative score combined with EVLWI for the diagnosis of ARDS was 0.86,the sensitivity was 85.61%,and the specificity was 74.34%,the cut-off values of semi quantitative score and EVLWI were 12.34 and 2.76,respective-ly.Conclusion Combined with pulmonary ultrasound and measurement of EVLWI by PiCCO has good accuracy in the early diagnosis of adult ARDS patients.