构建肺超声质量管理与控制方案对提高3种B线相关肺疾病诊断准确度的价值  

The Value of Construction of Lung Ultrasound Quality Management and Control Scheme in Improving the Diagnostic Accuracy of Three Types of Lung Diseases Related to B-Lines

作　　者：赵浩天[1] 王晓娜[1] 刘元琳 李丽[1] 薛红元[1] Zhao Haotian;Wang Xiaona;Liu Yuanlin;Li Li;Xue Hongyuan(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》2024年第11期1241-1244,共4页Chinese Journal of Ultrasound in Medicine

基　　金：河北省医学科学研究计划项目(No.20211264,20230337)。

摘　　要：目的分析3种B线相关肺疾病误诊原因,构建肺超声质量管理与控制方案,评价对诊断准确度的提升水平。方法组成肺超声质量管理与控制(质控)小组,对心源性肺水肿(CPE)、肺炎和间质性肺疾病(ILD)超声检查存在的问题进行分析,将质控前(2018年10月至2022年7月)病例分为诊断错误组与诊断正确组,比较超声诊断错误原因并进行多因素Logistic分析,并与质控后(2022年10月至2024年4月)进行诊断准确度比较。结果质控前诊断错误组与质控前诊断正确组相比,患者检查体位、配合程度、科室来源、超声图像质量、是否联合心脏及下腔静脉(IVC)超声差异有统计学意义(P<0.05);Logistic回归分析显示,患者科室来源(OR=2.829)、患者配合程度(OR=3.164)、医师接受肺超声理论学习(OR=6.125)、切面图像质量(OR=2.473)、是否联合心脏及IVC超声(OR=8.767)为诊断错误的独立危险因素(P<0.05);质控后与质控前相比,总诊断准确度(90.89%比83.48%,P<0.001)、CPE诊断准确度(92.33%比83.18%,P=0.001)和肺炎诊断准确度(85.33%比75.45%,P=0.004)均显著提高,ILD诊断准确度略有提高(95.00%比91.82%,P=0.141),但差异无统计学意义(P>0.05)。结论构建肺超声质控方案对提升肺超声诊断准确度有重要意义,应紧密结合实践,进一步完善肺超声检查规范性。Objective To analyze the causes of misdiagnosis of three lung diseases related to B-lines,the quality control scheme of lung ultrasound is constructed and its diagnostic value was evaluated.Methods The Lung ultrasound quality management and control scheme was formed to investigate the problems during ultrasound examination for cardiogenic pulmonary edema(CPE),pneumonia and interstitial lung disease(ILD).We analyzed the causes of misdiagnosis before quality control(October 2018 to July 2022),and compared the diagnostic accuracy with those correct after quality control(October 2022 to April 2024).Results Compared with the correct cases before quality control,there were statistically significant differences in the patient's examination position,patient cooperation,patient source,ultrasound image quality,combined with cardiac and inferior vena cava(IVC)ultrasound(all P<0.05).Logistic regression analysis showed that the patient source(OR=2.829),the patient's cooperation(OR=3.164),the doctor's theoretical learning of lung ultrasound(OR=6.125),the ultrasound image quality(OR=2.473),and combined with cardiac and IVC ultrasound(OR=8.767)were independent risk factors for diagnostic errors(all P<0.05).The total diagnostic accuracy(90.89%vs.83.48%,P<0.001),CPE(92.33%vs.83.18%,P=0.001)and pneumonia(85.33%vs.75.45%,P=0.004)were significantly higher than those before quality control(all P<0.05).The diagnostic accuracy of ILD(95.00%vs.91.82%,P=0.141)was not statistically significant(P>0.05).Conclusions The construction of lung ultrasound quality control indicators is of great significance to improve the accuracy of ultrasound diagnosis.It should be closely combined with practice to further improve the standardization of lung ultrasound examination.

关 键 词：质量管理与控制 肺超声 诊断准确度 B线 肺疾病 

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]