肺部超声评估重症肺炎严重程度及预后的价值  

The value of lung ultrasound score in evaluation of clinical severity and prognosis of severe pneumonia

作　　者：刘莹 邓西龙[1] 潘越峻[1] 蔡水江 黄煌[1] 李幼霞 刘勇进 LIU Ying, DENG Xilong, PAN Yuejun, CAI Shuijiang, HU-ANG Huang, LI Youxia, LIU Yongjin.(Intensive care Unit, Guangzhou Eighth People＇s Hospital, Guangzhou 510000, Chin)

机构地区：[1]广州市第八人民医院重症医学科,广州510000

出　　处：《实用医学杂志》2018年第12期2074-2078,共5页The Journal of Practical Medicine

基　　金：广州市科技计划项目(编号:201607010302);广州市健康协同创新重大专项(编号:201400000002)

摘　　要：目的探讨早期肺部超声评分(LUS)对重症肺炎患者病情严重程度及预后的评估价值,及与氧合指数(OI)、肺泡-动脉氧分压差(A-a DO_2)、淋巴细胞计数(LYM)、呼气末正压(PEEP)、急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)、临床肺部感染评分(CPIS)等传统参数的相关性。方法入选2015年5月至2017年7月重症医学科(ICU)收治的重症肺炎患者30例,其中存活15例,死亡15例,非病毒性肺炎17例,病毒性肺炎13例,低PEEP组13例,高PEEP组17例。一位观察者专门负责收集患者入院时的传统参数,另一位观察者专门负责肺部超声检查及评分,分析LUS与OI、A-a DO_2、LYM、PEEP、APACHEⅡ评分、CPIS的相关性,计算LUS对PEEP设置及病死率的预测值、敏感度和特异度。结果 LUS与OI(r=-0.755,P=0.000)和LYM(r=-0.518,P=0.03)显著负相关,与A-a DO_2(r=0.642,P=0.000)、PEEP(r=0.583,P=0.001)、APACHEⅡ评分(r=0.461,P=0.010)、CPIS(r=0.595,P=0.001)均呈显著正相关。非病毒性肺炎组与病毒性肺炎组LUS无明显差异(18.59±6.49 vs.18.69±6.56,P>0.05),存活组LUS明显低于死亡组(15.00±5.90 vs.22.27±4.68,P<0.01),低PEEP组LUS显著低于高PEEP组(14.23±5.40 vs.22.00±4.98,P<0.01);分析ROC曲线面积(AUC)得出,LUS 19分以上预测高PEEP机械通气敏感度为77%、特异度为92%,LUS 17分以上预测死亡的敏感度为87%、特异度为67%。结论床旁LUS可简单易行地反映肺部通气的改变,早期在评估重症肺炎患者病情严重程度及预后中具有重要临床应用价值。Objective To evaluate the application value of early lung ultrasound score（LUS）in the evaluation of severity and prognosis of severe pneumonia and investigate its correlations with oxygenation index（OI）,alveolar-arterial oxygen difference（A-aDO2）,lymphocyte count（LYM）,positive end-expiratory pressure（PEEP）,acute physiology and chronic health evaluationⅡ（APACHEⅡ）score,and clinical pulmonary infection score（CPIS）.MethodsThirty severe pneumonia patients admitted to intensive care unit（ICU）of Guangzhou Eighth People′s Hospital from May 2015 to July 2017 were enrolled,including 14 cases with low PEEP and 16 cases with high PEEP.Among them,17 patients were diagnosed with non-viral pneumonia and 13 ones with viral pneumonia;15 of them survived,and 15 died.The clinical data and cores of all patients were recorded by one observer,including baseline date,OI,A-aDO2,LYM,PEEP,and APACHEⅡand CPIS score.The other observer was specifically responsible for pulmonary ultrasonography and LUS.The correlation between LUS and OI,A-aDO2,LYM,PEEP,as well as APACHEⅡand CPIS scores was analyzed by bivariate correlation analysis.Receiver operator characteristic curves（ROC）were plotted,and the prediction value,sensitivity and specificity of high PEEP and mortality by LUS were calculated respectively.ResultsLUS had a negative correlation with OI（r=-0.755,P=0.000）and LYM（r=-0.518,P=0.03）,and a good positive correlation with A-aDO2（r=0.642,P=0.000）,PEEP（r=0.583,P=0.001）,APACHEⅡ（r=0.461,P=0.010）and CPIS（r=0.595,P=0.001）was respectively found.LUS in the survival group was significantly lower than the death group（15.00±5.90 vs.22.27±4.68,P〈0.01）,low PEEP group was obviously lower than high PEEP group（14.23±5.40 vs.22.00±4.98,P〈0.01）,and there was no significant difference between non-viral pneumonia group and viral pneumonia group（18.59±6.49 vs.18.69±6.56,P〉0.05）.The area under ROC cure（AUC）was calculated：the predictive value for high PEEP by LUS

关 键 词：床旁 肺部超声评分 重症肺炎 呼气末正压 病情严重程度 

分 类 号：R445.1[医药卫生—影像医学与核医学] R563.1[医药卫生—诊断学]