肺超声监测肺泡充气复张试验对肺实变合并肺不张的诊断价值  

Diagnostic Value of Alveolar Inflation Recruitment Test Monitored by Lung Ultrasound in Pulmonary Consolidation with Atelectasis

作　　者：赵浩天[1] 王晓娜[1] 刘元琳 刘奕 李丽[1] Zhao Haotian;Wang Xiaona;Liu Yuanlin;Liu Yi;Li Li(Department of Ultrasound,Hebei General Hospital,Shijiazhuang 050000,China)

机构地区：[1]河北省人民医院超声科,石家庄市050000

出　　处：《中国超声医学杂志》2023年第6期651-655,共5页Chinese Journal of Ultrasound in Medicine

基　　金：河北省医学科学研究计划项目(No.20211228、20211264)。

摘　　要：目的 探究肺超声监测肺泡充气复张试验(AIRT)对肺实变合并肺不张的诊断价值及临床意义。方法 67例经肺超声发现双肺均含肺实变征象的肺炎患者。动态观察深吸气过程,肺实变区征象转为B线或A线,定义为肺超声AIRT阳性,肺实变区征象无变化定义为肺超声AIRT阴性。同时动态观察支气管结构,以吸气时支气管内无流动感定义为静态支气管征。将肺超声AIRT阴性和静态支气管充气征联合:联合方案一,以二者可见其一即为阳性;联合方案二,以二者均可见为阳性。以胸部CT诊断肺实变是否合并肺不张。根据肺超声AIRT征象分为阳性组(38例)和阴性组(29例),对比两组间监护指标、实验室检查和超声指标的差异。结果 静态支气管征、肺超声AIRT阴性、联合方案一、联合方案二对肺实变合并肺不张的诊断准确度分别为67.16%、79.85%、67.91%和78.36%,灵敏度分别为74.51%、58.82%、84.31%和49.02%,特异度分别为62.65%、92.77%、57.83%和96.39%。与CT对比,肺超声AIRT和联合方案二的一致性均为中等,Kappa值分别为0.547、0.497(P<0.05);静态支气管征和联合方案一的一致性均较差,Kappa值分别为0.348、0.382(P<0.05)。肺超声AIRT阴性组的血压、氧饱和度、氧合指数水平均低于阳性组,呼吸频率、机械通气比例和血乳酸水平高于阳性组(P<0.05)。结论 肺超声动态观察肺泡充气复张试验对诊断肺实变是否合并肺不张有一定的诊断价值,经肺超声肺泡充气复张试验阴性的患者具有更低的收缩压、氧饱和度、氧合指数和更高的呼吸频率、机械通气比例和血乳酸水平。Objective To explore the diagnostic value and clinical significance of alveolar inflation recruitment test(AIRT)monitored by lung ultrasound in in patients with pulmonary consolidation and atelectasis.Methods A total of 67 cases of pneumonia with lung consolidation in both lungs were detected by lung ultrasound.The signs of lung consolidation area change into B-lines or A-lines during the dynamic process in deep respiration were defined as positive lung ultrasound AIRT,while no signs of change was defined as negative.The bronchial structure was also observed dynamically.The static bronchial sign was defined as no flow sensation in the bronchus during respiration.Negative lung ultrasound AIRT and static bronchial sign were combined in two modes:combination scheme I:one of the two can be seen grouped as positive;combination scheme II:both can be seen as positive.Chest CT was used to diagnose pulmonary consolidation with atelectasis.The patients were divided into positive group(38 cases)and negative group(29 cases)according to the lung ultrasound AIRT signs.The differences in monitoring indicators,laboratory tests and ultrasound indicators between the two groups were compared.Results The diagnostic accuracy of static bronchial sign,negative lung ultrasound AIRT,combination scheme I and II for pulmonary consolidation with atelectasis was 67.16%,79.85%,67.91%and 78.36%,respectively,the sensitivity was 74.51%,58.82%,84.31%and 49.02%,respectively,and the specificity was 62.65%,92.77%,57.83%and 96.39%.Using chest CT as gold standard,the consistency of lung ultrasound AIRT and combination scheme II was moderate,with Kappa values of 0.547 and 0.497,respectively(P<0.05).The consistency of static bronchial sign and combination scheme I was poor,with Kappa values at 0.348 and 0.382,respectively(P<0.05).The levels of blood pressure,oxygen saturation and oxygenation index in lung ultrasound AIRT negative group were lower than those in the positive group.The respiratory rate,mechanical ventilation ratio and blood lactate were hi

关 键 词：肺超声 肺不张 肺炎 肺泡充气复张试验 静态支气管征 

分 类 号：R445.1[医药卫生—影像医学与核医学] R563[医药卫生—诊断学]