经胸肺部超声彗尾征及血管外肺水指数在脓毒症患者预后评估中的价值  

Prognostic value of transthoracic lung ultrasound comet-tail and extravascular lung water index in septic patients

作　　者：张晓勤[1] 李春玲[1] 潘灵爱[1] 王艺萍[1] 黄晓波[1] Zhang Xiaoqin;Li Chunling;Pan Ling'ai;Wang Yiping;Huang Xiaobo(Department of Critical Care Medicme,Sichuan Academy of Medical Sciences&Sichuan Provincial People's Hospital,Chengdu 610072,Sichuan,China)

机构地区：[1]四川省医学科学院·四川省人民医院重症医学科,成都610072

出　　处：《中华危重病急救医学》2021年第8期985-989,共5页Chinese Critical Care Medicine

基　　金：四川省科技厅项目(2014SZ0011);四川省干部保健课题(川干研2019-219);四川省人民医院苗圃课题(2014043)。

摘　　要：目的探讨经胸肺部超声彗尾征及血管外肺水指数(EVLWI)对脓毒症患者预后的评估价值。方法采用前瞻性队列研究设计,入选2016年11月至2019年10月四川省人民医院重症监护病房(ICU)收治的60例脓毒症患者。应用脉搏指示持续心排血量(PiCCO)监测0、24、48、72 h EVLWI和肺血管通透性指数(PVPI);同一时间点经胸肺部超声检查,计算双肺(胸骨旁、锁骨中线、腋前线到腋中线)彗尾征总数;同时测定动脉血气分析,如pH值、中心静脉-动脉血二氧化碳分压差(Pcv-aCO_(2))、中心静脉血氧饱和度(ScvO_(2))、血乳酸(Lac)、氧合指数(PaO_(2)/FiO_(2))等,对彗尾征数目与EVLWI进行Pearson相关性分析。以28 d转归作为预后终点,采用多因素Logistic回归模型分析彗尾征数目、EVLWI等变量与预后结局的关系,并绘制受试者工作特征曲线(ROC曲线)预测患者预后。结果60例脓毒症患者中男性43例,女性17例;年龄31~83岁,平均(64.3±15.5)岁;肺部感染35例,腹腔感染10例,泌尿道感染6例,皮肤软组织感染3例,肠道感染3例,脑膜炎1例,蜂窝织炎1例,多发伤1例;8例并发急性呼吸窘迫综合征(ARDS);28 d存活40例(66.7%),死亡20例(33.3%)。Pearson相关性分析显示,彗尾征数目与EVLWI呈显著正相关(r=0.944,P<0.001)。不同原发感染灶脓毒症患者彗尾征数目差异存在统计学意义(H=17.714,P<0.001),肺部感染脓毒症患者彗尾征数目〔19(13,27)条〕明显多于其他部位感染患者;并发ARDS患者的彗尾征数目显著多于未合并ARDS患者〔条:27(19,30)比15(9,24),H=25.387,P<0.001〕。多因素Logistic回归分析显示,EVLWI、肺部超声彗尾征数目、PVPI为脓毒症患者死亡的独立危险因素〔优势比(OR)和95%可信区间(95%CI)分别为10.772(1.161~99.851)、2.360(1.070~5.202)、2.042(1.152~3.622),均P<0.05〕。基于肺部超声彗尾征和EVLWI构建的Logistic回归模型预测脓毒症患者28 d预后的准确率达90.0%,敏感度为90.0%,特异度�Objective To evaluate the prognostic value of transthoracic lung ultrasound comet-tail and extravascular lung water index(EVLWI)in septic patients.Methods A prospective cohort study was conducted.Sixty septic patients admitted to department of intensive care unit(ICU)of Sichuan Provincial People's Hospital from November 2016 to October 2019 were enrolled.The EVLWI and pulmonary vascular permeability index(PVPI)were determined by pulse-indicated continuous cardiac output(PiCCO)system at 0,24,48 and 72 hours.At the same time,the numbers of comet tail signs in both lungs(parasternal,midclavicular,axillary to midaxillary)were collected by chest ultrasound.Moreover,arterial blood gas analysis,such as pH value,central venous-to-arterial carbon dioxide difference(Pcv-aCO_(2)),central venous oxygen saturation(ScvO_(2)),blood lactic acid(Lac),PaO_(2)/FiO_(2)were measured.Pearson correlation analysis was performed between the number of comet-tail sign and EVLWI.Multivariate Logistic regression model was used to analyze the relationship between the number of comet-tail sign,EVLWI and prognosis.Receiver operator characteristic curve(ROC curve)was drawn to predict the prognosis.Results There were 43 males and 17 females in 60 septic patients.The average age was(64.3±15.5)years old(range:31-83 years old).There were 35 cases with pulmonary infection,10 cases with abdominal infection,6 cases with urinary tract infection,3 cases with skin and soft tissue infection,3 cases with intestinal infection,1 case with meningitis,1 case with cellulitis and 1 case with multiple injury.Acute respiratory distress syndrome(ARDS)occurred with 8 patients;40 patients(66.7%)survived and 20 patients(33.3%)died on day 28.Pearson correlation analysis showed that the number of comet-tail sign was positively correlated with EVLWI(r=0.944,P<0.001).There was significant difference in the number of comet-tail signs among sepsis patients with different primary infection sites(H=17.714,P<0.001).The number of comet-tail signs in sepsis patients with pulmona

关 键 词：脓毒症 超声检查 彗尾征 血管外肺水 LOGISTIC回归模型 

分 类 号：R459.7[医药卫生—急诊医学]