改良床旁肺部超声评估方案对重症患者肺实变和肺不张的诊断价值  

The value of bedside lung ultrasound in emergency-plus protocol for the assessment of lungconsolidation and atelectasis in critical patients

作　　者：王小亭[1] 刘大为[1] 张宏民[1] 何怀武[1] 刘晔[1] 柴文昭[1] 杜微[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院重症医学科,100730

出　　处：《中华内科杂志》2012年第12期948-951,共4页Chinese Journal of Internal Medicine

摘　　要：目的探讨改良床旁肺部超声评估方案（BLUE方案）对重症患者肺实变和肺不张的诊断价值。方法选呼吸衰竭需机械通气超过48h的患者，同时行床旁胸部X线、CT检查及BLUE方案、改良BLUE方案检查患者肺实变、肺不张情况，并与床旁胸部X线和CT对比，同时比较改良BLUE方案与BLUE方案评价肺实变与肺不张的差异。结果最终78例患者纳入本研究。胸部CT发现70例（89．74％）患者存在不同程度的肺实变、肺不张。床旁胸部X线诊断肺实变、肺不张的敏感性为31．29％，特异性为75．00％，诊断准确率为38．46％。改良BLUE方案发现68例患者存在肺实变、肺不张，诊断肺实变、肺不张的敏感性为95．71％，特异性为87．50％，诊断准确率为94．87％，与胸部cT比差异无统计学意义（P〉0．05）。BLUE方案发现48例患者存在肺实变、肺不张，诊断敏感性为65．71％，特异性为75．00％，诊断准确率为66．67％。BLUE方案未发现的肺实变、肺不张，胸部CT证实肺实变、肺不张部位主要位于双肺下叶后基底段。结论重症机械通气患者肺实变、肺不张发生率高，改良BLUE方案可以发现绝大部分肺实变、肺不张，具有较高的敏感性、特异性及诊断准确率，由于其具有即时、床旁、无创、可重复的优越性，将成为床旁评价重症患者肺实变、肺不张的首选的、重要的安全检查手段。Objective To investigate the effect of the bedside lung ultrasound in emergency （BLUE）-plus lung ultrasound protocol on lung consolidation and atelectasis of critical patients. Methods All patients who need to receive mechanical ventilation for more than 48 hours in ICU from June 2010 to December 2011 in Peking Union Medical College Hospital were included in the study. BLUE-plus and BLUE lung ultrasound, bedside X-ray, lung CT examination were performed on all patients at the same time. The condition of lung consolidation and atelectasis discovered by BLUE-plus lung ultrasound protocol was recorded and compared with bedside X-ray or lung CT. The difference in assessment of lung consolidation and atelectasis between BLUE-plus lung ultrasound protocol and BLUE protocol was compared. Results A total of 78 patients were finally enrolled in the study. The lung CT found 70 cases （89.74%） had different degrees of lung consolidation and atelectasis. The sensitivity, specificity and diagnostic accuracy of lung consolidation and atelectasis by the bedside chest X-ray were 31.29%, 75.00% and 38.46%, respectively. BLUE-plus lung ultrasound protocol found 68 cases with lung consolidation and ateIectasis, and its sensitivity, specificity, and diagnostic accuracy were 95.71%, 87.50% and 94. 87%, respectively, which were significantly higher than those of lung CT. BLUE protocol found 48 cases of lung consolidation and atelectasis, and its sensitivity, specificity, and diagnostic accuracy were 65.71%, 75.00% and 66. 67%, respectively. The position of lung consolidation and atelectasis which hadn＇t been found by BLUE protocol was mainly proved to be located in the basement of lung by lung CT. Conclusions The incidence of lung consolidation and atelectasis in critical patients who received mechanical ventilation is high. TheBLUE-plus lung ultrasound protocol has a relatively higher sensitivity, specificity and diagnostic accuracy for consolidation and atelectasis, which can find majority of consolidation and atelectasis.

关 键 词：超声检查 肺 肺不张 肺实变 危重症 

分 类 号：R459.7[医药卫生—急诊医学]