不同肺超声阳性诊断标准评价心源性肺水肿的价值比较

Comparison of value of different positive diagnostic criteria of lung ultrasound in evaluating cardiogenic pulmonary edema

目的比较3种肺超声阳性标准评估心源性肺水肿的效能,以筛选最优诊断标准,为临床快速诊断心源性肺水肿提供有效辅助手段。方法纳入2022年6月至2022年11月于上海交通大学医学院附属胸科医院行肺超声的患者98例。采用6点法(基于胸膜线和B线)进行肺超声检查,根据阳性点的个数及分布定义3种阳性标准:标准1为至少有2个阳性点;标准2为至少有3个阳性点;标准3为每侧至少有1个阳性点。比较3种肺超声阳性标准诊断心源性肺水肿的效能。分析3种肺超声阳性标准诊断心源性肺水肿与临床诊断的一致性。结果标准1、标准2、标准3的诊断灵敏度分别为88%、72%、79%,特异度分别为89%、100%、93%,准确度分别为87%、88%、87%。标准2对心源性肺水肿的诊断与临床最终诊断有较高的一致性(Kappa值=0.877);标准1及标准3对心源性肺水肿的诊断与临床最终诊断一致性一般(Kappa值分别为0.783、0.727)。结论3种肺超声阳性标准诊断心源性肺水肿的效能均较高,以“至少有3个阳性点”更有助于诊断。

Objective To compare the diagnostic efficacy of 3 lung ultrasound criteria in evaluating cardiogenic pulmonary edema,so as to obtain the optimal diagnostic criterion and to provide effective auxiliary measure for the rapid diagnosis of cardiogenic pulmonary edema.Methods A total of 98 patients who underwent lung ultrasound in the Shanghai Chest Hospital from June 2022 to November 2022 were included.Three positive criteria were defined according to the number and distribution of positive points based on the pleural and B lines:criterion 1 was set as at least 2 positive points;criterion 2 was set as at least 3 positive points;criterion 3 was set as at least 1 positive point on each side.The efficacies of 3 criteria in diagnosis of cardiogenic pulmonary edema,and their consistencies with clinical diagnosis were compared.Results The sensitivities of criterion 1,criterion 2,and criterion 3 were 88%,72%and 79%,the specificities was 89%,100%and 93%,the accuracies was 87%,88%and 87%,respectively.The criteri on 2 showed a higher consistency in the diagnosis of cardiogenic pulmonary edema with clinical diagnosis(Kappa value=0.877);the criterion 1 and criterion 3 were generally consistent in the diagnosis of cardiogenic pulmonary edema with clinical diagnosis(Kappa values were 0.783 and 0.727,respectively).Conclusions The diagnostic efficacies of the 3 positive lung ultrasound criteria for cardiogenic pulmonary edema are high,and“at least 3 positive points”is more helpful for clinical diagnosis.