基于心肺超声初诊的急性呼吸窘迫综合征9例并文献复习  

Cardiopulmonary ultrasound-based initial diagnosis of acute respiratory distress syndrome:Literature reviews of nine cases

作　　者：赵浩天[1] 燕亚茹 刘元琳 龙玲[2] 李丽[1] Zhao Haotian;Yan Yaru;Liu Yuanlin;Long Ling;Li Li(epartment of Ultrasound,Hebei General Hospital,Shijiazhuang 050000,China;Department of Intensive Care Unit,Hebei General Hospital,Shijiazhuang 050000,China;Graduate School,Hebei Medical University,Shijiazhuang 050017,China;Department of Ultrasound,Shijiazhuang People’s Hospital,Shijiazhuang 050000,China)

机构地区：[1]河北省人民医院超声科,河北石家庄050000 [2]河北省人民医院重症医学科,河北石家庄050000 [3]河北医科大学研究生学院,河北石家庄050017 [4]石家庄市人民医院超声科,河北石家庄050000

出　　处：《临床荟萃》2024年第8期741-746,共6页Clinical Focus

基　　金：河北省医学科学研究课题计划项目急重症超声联合心肺交互作用对急重症疾病的诊断价值(20211264);河北省医学科学研究课题计划项目心肺联合超声技术对急性呼吸循环功能障碍诊疗效能的研究(20211228)。

摘　　要：目的探讨经心肺超声作为首诊的急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者的影像学特征和诊断要点。方法分析2018年11月至2022年3月收治的经床旁心肺超声第一时间拟诊、且随后经临床确诊为ARDS的患者9例,分析其影像学特征并总结诊断要点,并分析其临床表现、实验室检查、预后等临床特点。结果9例ARDS中8例经心脏超声排除左心源性呼吸困难,1例显示左心室充盈压增高及肺毛细血管楔压增高,但经肺超声可排除心源性肺水肿;4例存在右室增大、3例右室收缩功能减低、7例肺动脉压增高;5例下腔静脉扩张、8例下腔静脉变异率减低。与ARDS“柏林定义”诊断标准相比,超声平均耗时较低(14.22±3.77 min比65.78±17.90 min,P<0.05)。结论心肺超声技术有助于初期作为ARDS的辅助诊断和评估的影像学工具,并评估肺部渗出情况、容量负荷、心功能及循环状况等,为临床医师下一步决策提供参考。Objective To explore the imaging characteristics and diagnostic points of patients with acute respiratory distress syndrome(ARDS)underwent cardiopulmonary ultrasound as the initial diagnosis.Methods Nine patients with an initial diagnosis of ARDS in our hospital from November 2018 to March 2022 through bedside ultrasound were selected.The imaging features and summarize diagnostic points were analyzed,as well as clinical manifestations,laboratory tests,prognosis,and other clinical characteristics.Results Among the nine cases of ARDS,left cardiogenic dyspnea was excluded by echocardiography in eight cases,and one case showed imaging findings of an increase in left ventricular filling pressure and pulmonary capillary wedge pressure,but excluded for cardiogenic pulmonary edema by lung ultrasound.There were four cases of right ventricular enlargement,three cases of decreased right ventricular systolic function,and seven cases of increased pulmonary artery pressure.Five cases of inferior vena cava dilation and eight cases of reduced inferior vena cava variability were detected.Compared with the Berlin Definition of ARDS,ultrasonic diagnosis of ARDS was significantly shorter(14.22±3.77 min vs 65.78±17.90 min,P<0.05).Conclusion Ultrasound is helpful as an imaging tool for early diagnosis and evaluation of ARDS,as well as for evaluating lung exudation,volume load,cardiac function,and circulatory status,providing reference for clinical physicians in next diagnosis and treatment decisions.

关 键 词：呼吸窘迫综合征 超声检查 血管外肺水 心功能 

分 类 号：R563.8[医药卫生—呼吸系统]