肺部超声在急性呼吸窘迫综合征严重程度评估中的应用  

Application of lung ultrasound in evaluating the severity of acute respiratory distress syndrome

作　　者：李嘉舟 蒋丽娜[1] 孟青[1] 王毅[1] LI Jiazhou;JIANG Li＇na;MENG Qing;WANG Yi(Department of Function,Dazhou Integrated Traditional Chinese and Western Medicine HospitaI,Sichuan 635000,Chin)

机构地区：[1]四川省达州市中西医结合医院功能科,635000

出　　处：《临床超声医学杂志》2018年第8期531-534,共4页Journal of Clinical Ultrasound in Medicine

摘　　要：目的探讨肺部超声在急性呼吸窘迫综合征(ARDS)严重程度评估中的应用。方法选取我院诊治的ARDS患者119例,均行胸部CT、肺部超声检查,并制定肺部超声评分(LUS),依据病情分为轻中度组67例和重度组52例,依据预后分为生存组72例和死亡组47例,比较其LUS评分、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、动脉血氧分压与吸入氧浓度比值(PaO_2/FiO_2)及呼气末正压(PEEP)。Pearson相关性分析法分析LUS与APACHEⅡ评分、PEEP及PaO_2/FiO_2的相关性。绘制LUS评估ARDS严重程度的受试者工作特征(ROC)曲线,并计算其效能。Logistic回归性分析ARDS患者死亡的独立影响因素。结果在LUS、APACHEⅡ评分及PEEP方面比较,重度组明显高于轻中度组,死亡组明显高于生存组(均P<0.05);在PaO_2/FiO_2比较,重度组明显低于轻中度组,死亡组明显低于生存组(均P<0.05)。相关性分析显示,LUS与APACHEⅡ评分、PEEP均呈正相关(r=0.763、0.593,均P<0.05),与PaO_2/FiO_2呈负相关(r=-0.637,P<0.05)。ROC曲线分析显示,以LUS 18.00分为截断值,其评估ARDS严重程度的敏感性、特异性及准确率分别为96.15%、94.03%及94.96%。Logistic回归性分析显示,LUS、APACHEⅡ评分、PEEP及PaO_2/FiO_2是ARDS患者死亡的独立影响因素(均P<0.05)。结论 LUS与ARDS患者APACHEⅡ评分、PaO_2/FiO_2及PEEP密切相关,可作为评估ARDS严重程度的重要指标,且上述指标是患者死亡的独立影响因素。Objective To explore the application of lung ultrasound in evaluating the severity of acute respiratory distress syndrome（ARDS）.Methods A total of 119 patients with ARDS were selected,they were underwent chest CT and lung ultrasonography,and the lung ultrasound score（LUS）was enacted. According to severity of illness,all patients were divided into mild-moderate groups（n=67）and severe group（n=52）,according to the prognosis,all patients were divided into survival group（n=72）and death group（n=47）,the LUS,the acute physiological and chronic health status score system Ⅱ（APACHE Ⅱ）score,the arterial oxygen pressure/inhalation oxygen concentration（PaO2/FiO2）level and the positive end-expiratory pressure（PEEP）level were compared between groups. The correlation between LUS and APACHE Ⅱ,PEEP and PaO2/FiO2 were analyzed by Pearson correlation analysis,and the ROC curve of LUS in evaluating ARDS severity was drawn,the efficacy was calculated,the independent factors affecting mortality in ARDS patients was analyzed by Logistic regression analysis.Results The LUS,APACHE Ⅱ score,PEEP in severe group were obviously higher than those in mild-moderate group,and those in death group were significantly higher than those in survival group（all P〈0.05）.The PaO2/FiO2 in severe group was significantly lower than that in mild-moderate group,and that in death group was significantly lower than that in survival group（all P〈0.05）.Pearson analysis showed LUS and APACHE Ⅱ score,PEEP levels were positively correlated（r=0.763,0.593,both P〈0.05）,and it was negatively correlated with PaO2/FiO2 levels（r=-0.637,P〈0.05）.ROC curve showed taken LUS was 18.00 as cutoff value,the sensitivity,specificity and accuracy of assessment of the severity of ARDS were 96.15%,94.03%,94.96%,respectively,which was basically consistent with the actual results.Logistic analysis showed the LUS,APACHE Ⅱ, PEEP level and PaO2/FiO2 were independent influence factors leads to the death（all P〈0.05）.Co

关 键 词：超声检查 肺 急性呼吸窘迫综合征 病情 严重程度 预后 

分 类 号：R445.1[医药卫生—影像医学与核医学]