肺部超声评分联合膈肌超声评估ARDS患者病情严重程度及预测预后的价值分析  

The value of pulmonary ultrasonography combined with diaphragmatic ultrasonography in evaluating the severity and prognosis of ARDS patients

作　　者：邱显鹏 黄小勇[1] 汪飞 QIU Xianpeng;HUANG Xiaoyong;WANG Fei(Department of Intensive Care Unit,Zigong Fourth People's Hospital,Zigong Sichuan 643000,China)

机构地区：[1]自贡市第四人民医院重症监护室,四川自贡643000

出　　处：《中国急救复苏与灾害医学杂志》2024年第9期1160-1165,共6页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：自贡市第四人民医院科研项目(编号:21zd009)。

摘　　要：目的探究肺部超声评分(LUS)联合膈肌超声评估急性呼吸窘迫综合征(ARDS)患者病情严重程度及预测预后的价值。方法根据病情程度将102例ARDS患者分为轻度组(n=38)、中度组(n=34)和重度组(n=30)。比较3组LUS、膈肌超声参数[膈肌厚度变化率(TF)、膈肌移动度(DM)],分析LUS、膈肌超声参数与ARDS患者病情程度的相关性,并统计ARDS患者28 d预后情况,比较不同预后患者一般资料、临床资料、LUS、膈肌超声参数,分析ARDS患者预后不良的影响因素,分析LUS、膈肌超声参数预测预后不良的价值,比较含与不含LUS、膈肌超声参数预测方案对ARDS患者预后不良的预测效能。结果重度组LUS高于中度组、轻度组,中度组LUS高于轻度组,重度组TF、DM低于中度组、轻度组,中度组TF、DM低于轻度组(P<0.05);ARDS患者LUS与病情程度呈正相关,TF、DM与病情程度呈负相关(P<0.05);预后不良患者入院时病情程度、PEEP、PVPI、EVLWI、APACHEⅡ评分、SOFA评分、LUS高于预后良好患者,TF、DM低于预后良好患者(P<0.05);病情程度、PEEP、PVPI、EVLWI、APACHEⅡ评分、SOFA评分、LUS均为ARDS患者预后不良的独立危险因素,TF、DM为保护因素(P<0.05);LUS、TF、DM预测ARDS患者预后不良的曲线下面积(AUC)分别为0.760、0.721、0.726;与基础预测方案比较,新预测方案预测预后不良的AUC明显增大,NRI、IDI均>0(P<0.05)。结论LUS、膈肌超声参数TF、DM与ARDS病情程度密切相关,联合应用有助于提高对预后的预测价值。Objective To investigate the value of lung ultrasound score(LUS)combined with diaphragm ultrasound in evaluating the severity and prognosis of acute respiratory distress syndrome(ARDS)patients.Methods 102 ARDS patients were divided into mild group(n=38),moderate group(n=34)and severe group(n=30).LUS and diaphragm ultrasound parameters[diaphragm thickness change rate(TF),diaphragm mobility(DM)]of the three groups were compared,and the correlation between LUS and diaphragm ultrasound parameters and the disease degree of ARDS patients was analyzed,and the prognosis of ARDS patients at 28 days was statistically analyzed,and the general data,clinical data,LUS and diaphragm ultrasound parameters of patients with different prognosis were compared.Furthermore,the influencing factors contributing to poor prognosis in ARDS patients were analyzed,along with the predictive value of LUS and diaphragm ultrasound parameters for poor prognosis.Finally,the effectiveness of prediction models with and without LUS and diaphragm ultrasound parameters in forecasting poor prognosis among ARDS patients was compared.Results LUS in severe group was higher than that in moderate group and mild group;LUS in moderate group was higher than that in mild group;TF and DM in severe group were lower than those in moderate group and mild group;TF and DM in moderate group were lower than those in mild group(P<0.05);LUS was positively correlated with the severity of ARDS,while TF and DM were negatively correlated with the severity of ARDS(P<0.05).The level of disease,PEEP,PVPI,EVLWI,APACHEⅡ score,SOFA score and LUS were higher in patients with poor prognosis than those with good prognosis,and TF and DM were lower than those with good prognosis(P<0.05).Disease degree,PEEP,PVPI,EVLWI,APACHEⅡ score,SOFA score and LUS were independent risk factors for poor prognosis in ARDS patients,TF and DM were protective factors(P<0.05).The area under the curve(AUC)of LUS,TF and DM in predicting poor prognosis of ARDS patients were 0.760,0.721 and 0.726,respective

关 键 词：急性呼吸窘迫综合征 肺部超声评分 膈肌超声 预后 

分 类 号：R563.8[医药卫生—呼吸系统] R445.1[医药卫生—内科学]