重症患者肺超声B线评分用于血管外肺水评估的临床研究  

The clinic study of extravascular lung water assessment by B - line scores of lung ultrasound in critical ill patients

作　　者：傅小云[1] 高飞[1] 苏德[1] 胡杰[1] 刘同华[1] 杨学忠[1] 

机构地区：[1]遵义医学院附属医院重症医学科,贵州遵义563003

出　　处：《中国急救医学》2014年第7期591-594,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨肺超声B线评分用于监测血管外肺水（EVLW）的价值及可行性。方法2013—01—2013—06在我院重症医学科住院患者，其中多发伤、闭合性胸外伤7例，重症肺炎2例，各种心脏器质性原因导致的心源性休克共7例，重症急性胰腺炎（SAP）并ARDS4例，分别用肺超声采集B线评分及脉搏分析连续心排量监测（PICCO）得到血管外肺水指数（EVLWI），观察比较治疗前后B线评分、EVLWI及氧合指数变化，对B线评分与EVLWI及氧合指数的相关性进行分析。结果所有患者均成功脱机拔除气管导管，治疗前后所有患者B线评分、EVLWI、氧合指数均较气管插管机械通气初始显著改善（P〈0．05）。Pearson相关分析表明，B线评分与氧合指数在P=0．05水平呈显著负相关（r=-0．505，P=0．028），B线评分与EVLWI在P=0．01水平呈显著正相关（r=0．808，P=0．001）。结论肺超声监测血管外肺水B线评分与PICCO获取的EVLWI具有良好相关性，肺超声B线评分可用于血管外肺水的监测及评价治疗效果。Objective To investigate the values and the feasibility of extravascular lung water （EVLW） assessment by B -line scores of lung ultrasound in critical ill patients. Methods Twenty hospitalization patients during January 2013 - June 2013 in the department of critical care medicine （ seven cases of multiple injuries and closed chest trauma, two cases of severe pneumonia, seven cases of cardiogenic shock, four cases of severe acute pancreatitis with ARDS） were included the study. Lung water assessment in all patients was by B - line scores of lung ultrasound or extravascular lung water index （EVLWI） of PICCO. The changes of B - line scores, PaO2/FiO2 and EVLWI were recorded during in ICU. The correlation of B - line scores, PaO2/FiO2 and EVLWI were analyzed. Results After treatment, mechanical ventilation was relieved and B- line scores, PaO2/FiO2 and EVLWI were improved significantly in all patients （ P 〈 0.05 ）. At the level of P = 0.05, B - line scores and PaO2/ FiO2 showed a negative correlation （ r =- 0. 505, P = 0. 028） and B - line scores and EVLWI showed a positive correlation （ r = 0. 808, P = 0.001 ）. Conclusion It shows a perfect correlation between B - line scores and EVLWI, and extravascular lung water assessment by B - line scores of lung ultrasound in critical ill patients can be potentially used to the clinic.

关 键 词：血管外肺水(EVLW) 肺超声 B线评分 脉搏分析连续心排量监测(PICCO) 氧合指数(PaO2 FiO2) 

分 类 号：R541.63[医药卫生—心血管疾病]