超声评估新型冠状病毒肺炎病情严重程度的临床价值  

The clinical value of ultrasound in the assessment of the severity of COVID-19

作　　者：冼建忠[1] 卢吴柱[1] 李睿卓 张舒珊 黄明星[2] 苏中振 Xian Jianzhong;Lu Wuzhu;Li Ruizhuo;Zhang Shushan;Huang Mingxing;Su Zhongzhen(Department of Ultrasound,Fifth Affiliated Hospital of Sun Yat-sen University,Zhuhai 519000,China;Department of Infectious Diseases,Fifth Affiliated Hospital of Sun Yat-sen University,Zhuhai 519000,China)

机构地区：[1]中山大学附属第五医院超声科,珠海519000 [2]中山大学附属第五医院感染科,珠海519000

出　　处：《中华超声影像学杂志》2020年第7期559-563,共5页Chinese Journal of Ultrasonography

摘　　要：目的:总结新型冠状病毒肺炎(COVID-19)患者肺部病变的超声表现,探讨超声评估COVID-19病情严重程度的临床价值。方法:选取2020年1月18日至2月5日中山大学附属第五医院住院收治的COVID-19患者31例,均行动态肺部超声检查,观察其肺部超声表现,并进行肺超声评分(LUS),分析LUS与临床分型及血氧合指数(PaO 2/FiO 2)的相关性,以及当LUS进展为中/重度时与对应的临床分型转变的关系。 结果:31例COVID-19患者中,2例(6.5%)超声未见明显病变,LUS 0分;29例(93.5%)显示肺部超声异常,LUS 1~26分,主要表现为B线征,6例(19.4%)合并"白肺征",13例(41.9%)合并肺实变征。LUS与临床分型呈正相关( r s=0.683 2, P<0.001);与PaO 2/FiO 2呈负相关( r=-0.864 3, P<0.001)。首次及动态超声检查中,13例患者LUS评为中/重度,LUS评估重型/危重型患者的准确率为81.3%(13/16)。LUS进展为中/重度的时间较临床分型提前1~3 d。 结论:COVID-19患者肺部超声表现具有一定的特征,主要表现为肺间质性病变,可合并肺部实变。超声可无创性评估COVID-19患者病情的严重程度,并指导临床治疗。Objective To summarize the ultrasound manifestations of lung lesions in patients with coronavirus disease 2019(COVID-19),and explore the clinical value of ultrasonography in assessing the severity of the disease.Methods Thirty-one patients with COVID-19 admitted to the Fifth Affiliated Hospital of Sun Yat-sen University from January 18 to February 5,2020,were selected as the research subjects.All of them underwent dynamic lung ultrasound.Their lung lesions were observed,and the lung ultrasound score(LUS)was performed,respectively.The correlations between the LUS and the disease classification,the LUS and the blood oxygenation index(PaO2/FiO2)were analyzed,respectively.The relationship between the corresponding change of clinical classification and the LUS score when it progressed to moderate/severe was analyzed as well.Results Among the 31 patients with COVID-19,two(6.5%)had no apparent lesions at the ultrasound,with the LUS score of 0.Twenty-nine(93.5%)showed abnormities at the ultrasound,with the LUS score from 1-26,and the main manifestations were B-line signs.Among them 6(19.4%)had the"white lung signs",and 13(41.9%)had pulmonary consolidations.The LUS score was positively correlated with the clinical classification(rs=0.6832,P<0.001)and negatively correlated with PaO2/FiO2(r=-0.8643,P<0.001).In the initial and dynamic ultrasonography,13 patients were graded as moderate/severe according to their LUS scores,and the accuracy of the LUS in assessing severe/critical patients was 81.3%(13/16).It was 1-3 days earlier for the LUS progressing to moderate/severe than clinical classification.Conclusions Pulmonary ultrasound manifestations of patients with COVID-19 have specific characteristics mainly showing as lung interstitial lesions,which can be combined with pulmonary consolidation.Ultrasound can be used in the assessment of the severity of COVID-19 noninvasively and guide clinical treatment.

关 键 词：超声检查 肺炎 新型冠状病毒肺炎 肺超声评分 

分 类 号：R563.1[医药卫生—呼吸系统]