肺部超声POCUS方案监测肺水肿的可行性评价  

Point of care lung ultrasound in the assessment of congestive heart failure

作　　者：徐峥嵘[1] 张娜雯 张耀 Xu Zhengrong;Zhang Nawen;Zhang Yao(Department of Cardiology,Shenzhen Baoan People's Hospital,Shenzhen 518101,China)

机构地区：[1]深圳市宝安区人民医院心血管内科,深圳518101 [2]广东医科大学,湛江524023

出　　处：《中国循证心血管医学杂志》2018年第6期702-705,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：深圳市宝安区科技局课题(2015003)

摘　　要：目的评价肺部超声POCUS方案对心力衰竭患者肺水肿监测可行性。方法筛选136例心力衰竭患者,于入院当天(T1)、住院第2 d(T2)及出院当天(T3)完善POCUS方案肺部超声检查和N端脑钠肽前体(NT-pro BNP)检验,统计分析B线与NT-pro BNP、6个月内心衰再住院或全因死亡事件的关系。结果心衰患者的NT-pro BNP由入院时(1908.95±684.63)pg/ml降至出院时(506.71±339.56)pg/ml,B线也相应地由19±5(T1)降至9±3(T3)条。spearman相关分析显示B线与NT-Pro BNP相关系数分别为r1=0.784、r2=0.719、r3=0.750(P均<0.05)。COX回归模型风险分析提示ULCs T3是充血性心衰患者预后的独立预测因素(HR=1.462,95%CI:1.159~1.961,P<0.05),Kaplan-Meier分析提示出院时ULCs T3≥10条组患者6个月内累积生存率明显低于ULCs T3<10条组(P<0.05)。结论肺超声POCUS方案是一种可靠的监测肺水肿方式,出院时B线可有效预测心衰住院患者短期心衰再住院或全因死亡发生。Objective To evaluate the feasibility of point of care lung ultrasound in the assessment of congestive heart failure(HF).Methods Serial clinical and ultrasound examinations were performed on 136 congestive HF patients within 24h of admission(T1),the second day in hospital(T2)and within 24h of discharge(T3).The examinations included NT-ProBNP,left ventricular ejection fraction(LVEF)and the number of B lines.Results The mean NT-ProBNP decreased from 1908.95±684.63 pg/ml(T1)to 506.71±339.56 pg/ml(T3),and the B lines declined from 19±5(T1)to 9±3(T3)simultaneously.Spearman correlation between of B lines and NTProBNP were r1=0.784,r2=0.719,r3=0.750,COX regression analysis indicated that the B lines at discharge was an independent predictor of prognosis(HR=1.462 95%CI:1.159~1.961,P<0.05).Kaplan-meier analysis suggested that the patients with B lines<10 at T3 had a higher non-event survival rate in 6 months.Conclusion Point of care lung ultrasound can reflect the changes of pulmonary edema in real time,and the number of B-lines at discharge is a strong predictor of rehospitalization or death for patients with congestive HF.

关 键 词：肺部超声 B线 肺彗尾征 心力衰竭 

分 类 号：R541.61[医药卫生—心血管疾病]