肺部超声在充血性心力衰竭中的应用现状和进展  

The application and progress of pulmonary ultrasound in congestive heart failure

作　　者：赵燕[1,2] 黄燕平[1,2] 李桐瑶 张蜀 ZHAO Yan;HUANG Yanping;LI Tongyao;ZHANG Shu(Emergency Department,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China;Emergency Department,Zigong Fourth People's Hospital,Zigong,Sichuan 643000,P.R.China)

机构地区：[1]四川大学华西医院急诊科,成都610041 [2]自贡市第四人民医院急诊科,四川自贡643000

出　　处：《华西医学》2019年第4期443-447,共5页West China Medical Journal

摘　　要：近年来随着超声技术的发展,肺部超声越来越多地应用于心力衰竭患者的评估。肺部超声B线是从胸膜线出现延伸至屏幕底部的离散垂直混响伪像影,与充血性心力衰竭(congestive heart failure,CHF)时血管外肺水成正比,具有不发生衰减、与胸膜滑行同步运动的特点。肺部超声评估CHF的严重程度时,主要是记录区域内B线数目和宽度,具有有效、无创、即时、重复性好的特点。目前应用于评估CHF的肺超声分区法有4分区法、8分区法、12分区法、28分区法等,分区越多,操作时间越长,敏感性和特异性不同,临床中选用何种分区方法尚有争议。在临床中肺部超声可以单独应用,也可以与脑钠肽、超声心动图、胸部X线片、胸部CT等检查联合,用于CHF的早期诊断、判断病情严重程度、评价疗效、预测预后,具有不同的优缺点。该文就肺部超声在CHF中的应用现状和进展进行了综述。In recent years,with the development of ultrasound technology,pulmonary ultrasound is more and more used in the evaluation of patients with heart failure.B-lines are defined as reverberation artifacts starting from the pleural line and extending to the bottom of the screen without disappearing,and moving synchronously with pleural sliding,which are proportional to extravascular lung water in congestive heart failure(CHF).B-lines have the characteristics of no attenuation and synchronous movement with pleural sliding.Pulmonary ultrasound mainly record the numbers and widths of B-lines in the areas when assessing the severity of CHF,which have the characteristics of effectivity,non-invasiveness,instantaneousness,and good repeatability.Currently,there are 4-,8-,12-,and 28-subdivision methods for the evaluation of CHF in the pulmonary ultrasound subdivision method.The more subdivisions are,the longer the operation time will be,and the sensitivity and specificity will be different.How to choose a subdivision method is still controversial in clinical practice.Lung ultrasound could be used alone or combined with brain natriuretic peptide,echocardiography,chest X-ray,chest CT scan,etc.in the early diagnosis,assessment of disease severity,evaluation of efficacy,and assessment of prognosis of CHF,with different advantages and disadvantages.This article reviews the application and progress of pulmonary ultrasound in CHF.

关 键 词：充血性心力衰竭 肺部超声 B线 

分 类 号：R541.6[医药卫生—心血管疾病] R445.1[医药卫生—内科学]