急诊及床旁肺脏超声检查在急性呼吸窘迫综合征患者中的临床应用价值  

Clinical Application Value of Emergency and Bedside Pulmonary Ultrasound in Patients with Acute Respiratory Distress Syndrome

作　　者：侯晓慧 张明琴 HOU Xiaohui;ZHANG Mingqin(Department of Ultrasound Medicine,the Fourth Affiliated Hospital of Nanjing Medical University,Nanjing 210000,China)

机构地区：[1]南京医科大学第四附属医院超声医学科,江苏南京210000

出　　处：《中华灾害救援医学》2025年第1期61-64,共4页Chinese Journal of Disaster Medicine

基　　金：2024年度南京市卫生科技发展专项资金资助项目(YKK24236)。

摘　　要：目的探讨对于急性呼吸窘迫综合征的患者,实施急诊和床旁肺脏超声检查的临床应用价值。方法回顾性分析2019年1月至2024年7月南京医科大学第四附属医院收治的90例疑似急性呼吸窘迫综合征患者的临床资料。所有患者均行胸部CT和肺脏超声检查。分析胸部CT及肺脏超声检查结果以及肺脏超声在急性呼吸窘迫综合征患者是否成功撤机中的评估价值。结果90例疑似急性呼吸窘迫综合征患者中,70例患者胸部CT检查均呈现不同程度的阳性征象:主要包括小叶间隔增厚、磨玻璃密度影、肺部斑片影、支气管充气征、胸腔积液;63例患者肺脏超声检查呈现不同程度的阳性征象。以胸部CT检查为诊断的急性呼吸窘迫综合征“金标准”,肺脏超声诊断急性呼吸窘迫综合征的肺脏超声的灵敏度为92.86%,特异度为65%,准确度为86.67%。一致性检验Kappa值为0.601。70例急性呼吸窘迫综合征患者中,62例患者成功撤机,占比88.57%,8例患者未成功撤机,占比11.2%。两组研究对象性别、年龄、机械通气时间、吸入氧浓度、氧合指数、心率、平均动脉压均无显著差异(P>0.05)。与未成功撤机组患者相比,成功撤机组患者肺脏超声评分更低(P<0.001),最大呼气和吸气末膈肌厚度更高(P<0.001)。Spearman相关性分析显示,肺脏超声评分、最大呼气和吸气末膈肌厚度与能否成功撤机具有相关性。结论肺脏超声作为一种非侵入性、便捷且具有较高灵敏度的影像学检查方法,在急性呼吸窘迫综合征的筛查和诊断中具有重要价值。肺脏超声评分可作为临床医生评估撤机时机的重要辅助工具。Objective To assess the clinical value and significance of emergency and bedside pulmonary ultrasound in patients with acute respiratory distress syndrome(ARDS).Methods A retrospective analysis was conducted on the clinical data of 90 patients suspected of having ARDS who presented at the Fourth Affiliated Hospital of Nanjing Medical University between January 2019 and July 2024.All patients underwent chest computed tomography(CT)and pulmonary ultrasound examinations.The results of chest CT and pulmonary ultrasound were analyzed,focusing on the assessment value of pulmonary ultrasound in determining the success of weaning from mechanical ventilation in ARDS patients.Results Among the 90 patients suspected of having ARDS,70 exhibited varying degrees of positive findings on chest CT,including interlobular septal thickening,ground-glass opacities,pulmonary consolidations,bronchial vascular signs,and pleural effusions.Additionally,63 patients showed positive ultrasound findings to varying degrees.Using chest CT as the diagnostic"gold standard"for ARDS,the sensitivity of pulmonary ultrasound in diagnosing ARDS was found to be 92.86%,with a specificity of 65%and an accuracy of 86.67%.The Kappa value for consistency testing was 0.601.Among the 70 ARDS patients,62 were successfully weaned from mechanical ventilation,representing 88.57%,while 8 patients were not successfully weaned,accounting for 11.2%.There were no significant differences between the two groups concerning gender,age,duration of mechanical ventilation,inhaled oxygen concentration,oxygenation index,heart rate,or mean arterial pressure(P>0.05).Compared to the unsuccessful weaning group,the successful weaning group had significantly lower pulmonary ultrasound scores(P<0.001)and higher maximal expiratory and inspiratory diaphragmatic thicknesses(P<0.001).Spearman correlation analysis indicated a correlation between pulmonary ultrasound scores,maximal diaphragmatic thickness at expiration and inspiration,and the success of weaning.Conclusion Pulmonary ultrasou

关 键 词：肺脏超声 急性呼吸窘迫综合征 机械通气 

分 类 号：R563.8[医药卫生—呼吸系统]