肺部超声与脉搏指示连续心排血量监测评价急性心力衰竭患者肺水肿程度  

Lung ultrasound and pulse indicator continuous cardiac output for monitoring degree of pulmonary edema in patients with acute heart failure

作　　者：杨菲菲 王秋霜 冯国强[2] 张丽伟 马永江 陈强 熊敏俊 李敏 王淑华 YANG Feifei;WANG Qiushuang;FENG Guoqiang;ZHANG Liwei;MA Yongjiang;CHEN Qiang;XIONG Minjun;LI Min;WANG Shuhua(Department of Cardiology,the Fourth Medical Center of Chinese PLA General Hospital,Beijing 100048,China;Department of Outpatient,Harbin Second Retired office of Heilongjiang Military Command,Harbin 150001,China)

机构地区：[1]中国人民解放军总医院第四医学中心心内科,北京100048 [2]黑龙江省军区哈尔滨第二离职干部休养所门诊部,黑龙江哈尔滨150001

出　　处：《中国医学影像技术》2021年第5期684-688,共5页Chinese Journal of Medical Imaging Technology

基　　金：解放军总医院临床科研扶持基金(三〇四专项)计划(2018FC-304M-CXYY-01)。

摘　　要：目的对比肺部超声与脉搏指示连续心排血量监测(PiCCO)评价急性心力衰竭肺水肿的价值。方法对11例急性心力衰竭患者先后行常规超声心动图、肺部超声及PiCCO,共获得26例/次数据,将其分为轻度组[血管外肺水指数(EVLWI)≤10 ml/kg,n=12]和重度组(EVLWI>10 ml/kg,n=14),比较组间血清N末端B型脑钠肽前体(NT-proBNP)值、超声及PiCCO参数的差异。采用Spearman相关性分析各指标与EVLWI的相关性;绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),判断各指标评价肺水肿的效能。结果轻度组舒张压及左心室射血分数(LVEF)明显高于重度组(P均<0.05);NT-proBNP、心率、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、肺动脉压(PAP)、下腔静脉直径(IVCD)、E/e'、B线总分、全心舒张末期容积指数(GEDVI)及EVLWI明显低于重度组(P均<0.05)。B线总分与EVLWI呈显著正相关(r=0.955,P<0.001);其诊断EVLWI>10 ml/kg的AUC为0.95,截断值为15.00时,敏感度为92.90%,特异度为66.70%。结论肺部超声可较准确地评价急性心力衰竭患者肺水肿程度;B线总分与EVLWI呈显著性相关。Objective To observe the value of lung ultrasound and pulse indicator continuous cardiac output(PiCCO)for monitoring pulmonary edema in patients with acute heart failure.Methods Eleven patients with acute heart failure were enrolled,and a total of 26 times of echocardiography,lung ultrasound and PiCCO were performed,and the data were divided into mild group(external venous lung water index[EVLWI]less than or equal to 10 ml/kg,n=12)and severe group(EVLWI more than 10 ml/kg,n=14).N-terminal pro-B-type natriuretic peptide(NT-proBNP)values,ultrasound and PiCCO parameters were compared between 2 groups.Spearman correlation was used to analyze the correlation between each parameter and EVLWI.Receiver operating characteristic(ROC)curves were drawn,and the area under the curve(AUC)was calculated to analyze the efficacy of each parameter in evaluating pulmonary edema.Results Diastolic blood pressure and left ventricular ejection fraction(LVEF)in mild group were significantly higher than those in severe group(both P<0.05).NT-proBNP,heart rate,left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),pulmonary artery pressure(PAP),inferior vena cava diameter(IVCD),E/e',total scores of line B,global end diastolic volume index(GEDVI)and EVLWI in mild group were all significantly lower than those in severe group(all P<0.05).The total scores of line B strongly and positively correlated with EVLWI(r=0.955,P<0.001),and the AUC of EVLWI more than 10 ml/kg for diagnosing pulmonary edema was 0.95.Taken 15.00 as the cutoff value,the sensitivity was 92.90%,and the specificity was 66.70%.Conclusion Lung ultrasound could accurately evaluate the degree of pulmonary edema in patients with acute heart failure.The total scores of line B was significantly correlated with EVLWI.

关 键 词：心力衰竭 肺水肿 超声检查 超声心动描记术 

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