对比床旁急诊肺超声与联合心肺及附加超声诊断急性呼吸困难病因的准确性  

Comparison on accuracy of bedside lung ultrasound in emergency and combined cardiac-lung and additional ultrasound for diagnosing causes of acute dyspnea

作　　者：赵浩天[1] 刘奕 刘元琳 王晓娜[1] 燕亚茹 牛慧敏[1] 赵鹤龄 薛红元[1] 李丽[1] ZHAO Haotian;LIU Yi;LIU Yuanlin;WANG Xiaona;YAN Yaru;NIU Huimin;ZHAO Heling;XUE Hongyuan;LI Li(Department of Ultrasound,3.Department of Intensive Care Unit,Hebei General Hospital,Shijiazhuang 050000,China;Department of Ultrasound,Shijiazhuang Peoples’Hospital,Shijiazhuang 050000,China)

机构地区：[1]河北省人民医院超声科 [2]河北省人民医院重症医学科,河北石家庄050000 [3]石家庄市人民医院超声科,河北石家庄050000

出　　处：《中国介入影像与治疗学》2024年第3期134-138,共5页Chinese Journal of Interventional Imaging and Therapy

基　　金：河北省医学科学研究课题计划项目(20231609,20211264,20211228);河北省政府资助临床医学优秀人才培养和基础课题研究项目(361003)。

摘　　要：目的对比床旁急诊肺超声(BLUE)与联合心肺及附加超声(CLAUS)方案诊断急性呼吸困难病因的准确性。方法回顾性分析1016例急性呼吸困难患者,根据病因分为心源性肺水肿组(n=268)、肺炎组(n=574)、气胸组(n=33)、肺栓塞组(n=67)及CAD(慢性阻塞性肺疾病/哮喘/膈肌功能障碍)组(n=74);比较各组CLAUS所见,以及BLUE与CLAUS方案诊断急性呼吸困难病因的准确性。结果CLAUS显示,心源性肺水肿组肺超声表现多呈BB及B-C模式,肺炎组多为A-B、A-C、B-A、B-B、B-C及C-C模式,气胸组、肺栓塞组及CAD组均以A-A模式最多。5组肺超声表现、前胸壁胸膜特征、有无左/右心功能不全及有无下腔静脉内径异常差异均有统计学意义(P均<0.05)。BLUE与CLAUS方案诊断急性呼吸困难病因的准确率分别为86.91%(883/1016)及94.49%(960/1016),后者高于前者(χ^(2)=34.587,P<0.05)。结论CLAUS方案可有效诊断急性呼吸困难病因,其准确率高于BLUE方案。Objective To compare the accuracy of bedside lung ultrasound in emergency(BLUE)and combined cardiaclung and additional ultrasound(CLAUS)for diagnosing the causes of acute dyspnea.Methods Totally 1016 patients with acute dyspnea were retrospectively enrolled and divided into cardiogenic pulmonary edema group(n=268),pneumonia group(n=574),pneumothorax group(n=33),pulmonary embolism group(n=67)and CAD(chronic obstructive pulmonary disease/asthma/diaphragmatic dysfunction)group(n=74)according to the causes of acute dyspnea.The findings of CLAUS protocol were compared among groups,and the accuracy of BLUE and CLAUS protocol for diagnosing the causes of acute dyspnea were also compared.Results CLAUS showed that B-B and B-C were the most common modes in cardiogenic pulmonary edema group,while A-B/A-C/B-A/B-B/B-C/C-C modes were common in pneumonia group,and A-A mode was the most common in pneumothorax group,pulmonary embolism group and CAD group.Significant differences of the manifestations of pulmonary ultrasound,pleural feature of anterior chest wall,left/right cardiac insufficiency and abnormal inferior vena cava diameter were found among groups(all P<0.05).The accuracy of BLUE and CLAUS protocol for diagnosing the causes of acute dyspnea was 86.91%(883/1016)and 94.49%(960/1016),respectively,the latter was higher than the former(χ^(2)=34.587,P<0.05).Conclusion CLAUS protocol could be used to effectively diagnose the causes of acute dyspnea,with higher accuracy than BLUE protocol.

关 键 词：呼吸困难 肺水肿 肺炎 气胸 肺栓塞 超声检查 

分 类 号：R56[医药卫生—呼吸系统] R445.1[医药卫生—内科学]