肺部超声对成年患者术后肺不张、胸腔积液和气胸诊断价值的meta分析

Diagnostic value of lung ultrasound in diagnosing postoperative atelectasis,pleural effusion and pneumothorax in adult patients:a systematic review and meta-analysis

目的通过meta分析评估肺部超声(LUS)诊断成年患者术后肺不张、胸腔积液和气胸的价值。方法在PubMed、Embase、Cochrance Library、Web of Science、万方、维普和中国知网数据库进行检索。纳入比较LUS、胸部X光片(CXR)或计算机断层扫描(CT)诊断术后肺不张、胸腔积液和气胸准确性的观察性研究,指标为LUS诊断术后肺不张、胸腔积液、气胸的灵敏度、特异度及拟合受试者工作特征曲线下面积(AUC)。采用MetaDiSc 1.4、Review Manager 5.4和STATA 16.0软件进行分析。以CXR和CT作为标准影像学检查方法,计算LUS的合并灵敏度、特异度及AUC。同时对手术类型、标准影像学检查方法(CXR、CT)、CXR(CT)/LUS检查时间间隔(>3 h、≤3 h)和术后LUS检查时间点进行meta回归分析。结果最终纳入15篇文献,共1585例患者。LUS诊断术后肺不张、胸腔积液和气胸的合并灵敏度分别为0.91(95%CI 0.88~0.93)、0.75(95%CI 0.71~0.78)和0.53(95%CI 0.48~0.58),合并特异度分别为0.96(95%CI 0.95~0.97)、0.82(95%CI 0.81~0.84)和0.94(95%CI 0.93~0.95),AUC分别为0.9368(SE=0.0442)、0.8397(SE=0.0767)和0.9147(SE=0.0309)。meta回归分析显示手术类型是影响LUS诊断气胸的异质性来源(P=0.001),标准影像学检查方法是影响LUS诊断胸腔积液的异质性来源(P=0.023)。结论LUS诊断成年患者术后肺不张和胸腔积液的准确性较高。LUS对非临床相关气胸(≤3 cm)的检出能力较弱,其诊断术后气胸的总体灵敏度较低但是特异度较高。

Objective To systematically evaluate the diagnostic value of lung ultrasound(LUS)in diagnosing postoperative atelectasis,pleural effusion and pneumothorax in adult patients.Methods PubMed,Embase,Cochrane Library,Web of Science,Wanfang Database,China Science and Technology Journal Database and China National Knowledge Infrastructure were searched for studies comparing the accuracy of LUS Chest radiograph(CXR)or computed tomography(CT)in the diagnosis of postoperative atelectasis,pleural effusion and pneumothorax,and the parameters were the sensitivity and specificity of LUS in diagnosing postoperative atelectasis,pleural effusion and pneumothorax,and the area under the receiver operating characteristic curve(AUC).Analysis was performed using MetaDiSc 1.4,Review Manager 5.4,and STATA 16.0 softewares.CXR and CT were used as standard imaging examination methods,and the combined sensitivity,specificity and AUC of LUS were calculated.Meta regression analysis was conducted on the types of surgeries,standard imaging examination methods(CXR,CT),CXR(CT)/LUS examination intervals(>3 h,≤3 h),and time points of postoperative LUS examination.Results Fifteen studies involving 1585 patients were finally enrolled in the present study.The combined sensitivity of LUS in diagnosing postoperative atelectasis,pleural effusion and pneumothorax was 0.91(95%confidence interval[CI]0.88-0.93),0.75(95%CI 0.71-0.78)and 0.53(95%CI 0.48-0.58),respectively,and the combined specificity was 0.96(95%CI 0.95-0.97),0.82(95%CI 0.81-0.84)and 0.94(95%CI 0.93-0.95),respectively,and AUC was 0.9368(SE=0.0442),0.8397(SE=0.0767)and 0.9147(SE=0.0309),respectively.Meta-regression analysis showed that the type of surgery was a source of heterogeneity affecting the diagnosis of pneumothorax by LUS(P=0.001),and the standard imaging examination method was the source of heterogeneity affecting the diagnosis of pleural effusion by LUS(P=0.023).Conclusions Although LUS has a weak ability in detecting non-clinically related pneumothorax(≤3 cm)and a low overall sensitivity in diagnosing postoperative pneumothorax,the specificity is high in adult patients.