急诊室超声颈内静脉截面积测定对心源性呼吸困难诊断的应用研究  

作　　者：何许伟[1] 刘宏[1] 潘柳华[1] 邱倩文 邓华东[1] 楼天正[1] 

机构地区：[1]浙江省丽水市人民医院,323000

出　　处：《浙江临床医学》2016年第9期1604-1605,共2页Zhejiang Clinical Medical Journal

基　　金：浙江省丽水市医学重点学科项目（2014zdxk05）

摘　　要：目的探讨超声测量颈内静脉面积（IJARs）鉴别心源性和非心源性呼吸困难的临床价值方法在急诊室应用超声测量47例呼吸困难患者IJARs及心脏左室射血分数（EF），同时测量脑钠肽（BNP），超声检查由超声科医师测量，其对t临床情况及BNP及IJARs不知晓。结果最终心源性呼吸困难患者23例，非心源性呼吸困难患者24例，IJARs与BNP相关性，r=0．696（P〈0．001）以EF诊断为金标准，采用ROC曲线分析IJARs预测心源性呼吸困难，曲线下面积为0869（P〈0．05），95％可信区间0．761-0．976，综合灵敏度和特异度，可知SV面积预测心源性呼吸困难的Cut—off值为4451。联合1JARs及BNP预测心源性呼吸困难，曲线下面积为0．789（P〈0．05），95％可信区间为O．652-0．926，预测的灵敏度为O．800，特异度为O．778，阳性似然比为3604，阴性似然比为0．257。结论颈内静脉截面积测量可以作为急诊呼吸困难鉴别诊断的有效手段。Objective To investigate diagnosis value of I JARs in patients with dyspnea in emergency department in patients with dyspnea （ cardiac dyspnea or pulmonary dyspnea ） . Methods 47 patients with dyspnea were measured concentration of 1JARs, BNP, left ventricular ejection fraction （ EF ） . Congestive heart failure by C-ECHO was determined by the final reading of board-certified cardiologists blinded to the Results of JVD- US and all clinical data, including BNE Results Cardiac dyspnea cases of 23 cases of non cardiac dyspnea in 24 cases, Internal jugular vein cross- sectional area （ IJARs ） and BNP correlation, r value was 0.696 （ P〈0.001 ） , with statistical significance. Using ROC curve analysis of IJARs ） to predict cardiac dyspnea, as shown in the figure below as a result, the area under the curve was 0.869 （ P〈0.05 ） and 95% confidence interal CI, 0.761- 0.976, Cut-off a value of 44.51. Joint 1JARs and BNP predicts cardiac dyspnea I JARs using ROC curve analysis and BNP predicts cardiac dyspnea, the results of the diagram below, the area under the curve was 0.789 （ P〈0.05 ） and 95% confidence interal, 0.652-0.926, the sensitivity of prediction was 0.800, specific degree was 0.778, positive likelihood ratio was 3.604, the negative likelihood ratio. Conclusion Internal jugular vein cross-sectional are （ I JARs ） measurement can be a important tool for diagnosing dyspnea in ED.

关 键 词：急诊呼吸困难 超声检查 颈内静脉截面积 敏感性 特异性 

分 类 号：R56[医药卫生—呼吸系统]