床旁超声联合超声心动图在快速诊断心源性呼吸困难与肺源性呼吸困难中的应用价值分析  

Application value analysis of bedside ultrasound combined with echocardiography in the rapid diagnosis of cardiogenic dyspnea

作　　者：许碧芳 周泉 夏宗敏 XU Bi-fang;ZHOU Quan;XIA Zong-min(Department of Ultrasound Medicine,Maanshan Seventeen Metallurgical Hospital,Maanshan Anhui 243000,China)

机构地区：[1]马鞍山十七冶医院超声医学科,安徽马鞍山243000

出　　处：《临床和实验医学杂志》2024年第16期1764-1767,共4页Journal of Clinical and Experimental Medicine

基　　金：安徽省医学会临床研究项目(编号:2020001539)。

摘　　要：目的探讨床旁超声联合超声心动图在快速鉴别诊断心源性呼吸困难(CD)与肺源性呼吸困难(PD)中的价值。方法将2020年2月至2023年2月马鞍山十七冶医院收治的100例急性呼吸困难患者纳入本次回顾性研究,根据病因不同分为PD组(n=41)和CD组(n=59)。两组患者均在入院当天接受床旁超声检查和超声心动图检查,收集和比较两组床旁超声检查和超声心动图检查指标[B线总数、左室舒张末期内径(LVEDD)、左心房内径(LA)、二尖瓣口舒张早期血流速度(E)与二尖瓣环舒张早期运动速度(e')之比(E/e')、左心室射血分数(LVEF)]和血清N末端脑钠肽(NT-proBNP);以综合诊断结果结果为“金标准”,计算床旁超声联合超声心动图的诊断符合率;采用Pearson相关性分析B线总数与LVEDD、LA、E/e'、LVEF、血清NT-proBNP的相关性。结果床旁超声联合超声心动图诊断CD的符合率为93.22%(47/51),诊断PD的符合率为90.24%(37/41),漏诊率为8.00%(8/100)。CD组的B线总数、LVEDD、LA、E/e'、血清NT-proBNP分别为(18.85±3.58)条、(55.03±2.09)mm、(42.39±2.44)mm、16.83±2.54、(3998.54±598.17)ng/L,均显著高于PD组[(7.02±2.31)条、(46.75±1.80)mm、(34.70±2.13)mm、7.42±1.96、(595.07±230.71)ng/L],而CD组的LVEE为(42.98±3.04)%,显著低于PD组[(60.76±2.83)%],差异均有统计学意义(P<0.05)。B线总数与LVEDD、LA、E/e'、NT-proBNP呈线性正相关(r=0.692、0.711、0.571、0.455,P<0.05),与LVEF呈负相关(r=-0.892,P<0.05)。结论床旁超声联合超声心动图在CD/PD中的诊断符合率较高,且在快速鉴别诊断急性呼吸困难病因中有较高的应用价值。Objective To explore the application value of bedside ultrasound combined with echocardiography in the rapid differential diagnosis of cardiogenic dyspnea(CD)and pulmonary dyspnea(PD).Methods A total of 100 patients with acute respiratory distress admitted to Maanshan Seventeen Metallurgical Hospital from February 2020 to February 2023 were included in this retrospective study.According to the different etiologies,they were divided into the PD group(n=41)and the CD group(n=59).Both groups of patients underwent bedside ultrasound and echocardiography on the same day of admission.The bedside ultrasound and echocardiography related indexes [The total number of B lines,left ventricular end-diastolic diameter(LVEDD),left atrial diameter(LA),the ratio of early diastolic mitral flow velocity(E)to early diastolic mitral annulus velocity(e')(E/e'),left ventricular ejection fraction(LVEF)],and serum N-terminal pro-brain natriuretic peptide(NT-proBNP)detected by enzyme linked immunosorbent assaywere collected and compared.The diagnostic accordance rate of bedside ultrasound combination with echocardiography was calculated using the comprehensive diagnostic results as the"gold standard".The correlation of the total number of B-lines with LA,LVEDD,LVEF,E/e'and serum NT-proBNP were analyzed by Pearson correlation analysis.Results The diagnostic accordance rate of bedside ultrasound combined with echocardiography for CD was 93.22%(47/51),and the diagnostic accordance rate for PD was 90.24%(37/41),with a missed diagnosis rate of 8.00%(8/100).The the total number of B-lines,LVEDD,LA,E/e',and serum NT-proBNP in the CD group were(18.85±3.58)bands,(55.03±2.09)mm,(42.39±2.44)mm,16.83±2.54,and(3998.54±598.17)ng/L,respectively,which were much higher than those in the PD group[(7.02±2.31)bands,(46.75±1.80)mm,(34.70±2.13)mm,7.42±1.96,and(595.07±230.71)ng/L],the LVEF in the CD group was(42.98±3.04)%,which was lower than that in the PD group[(60.76±2.83)%],the differences were statistically significant(P<0.05).There was a posit

关 键 词：急性呼吸困难 床旁超声 超声心动图 诊断 

分 类 号：R540.45[医药卫生—心血管疾病]