肺部超声B线数目与血管外肺水及氧合指数的相关性分析
肺部超声B线数目与血管外肺水及氧合指数的相关性分析
【摘要】
目的:评估ARDS患者的B线评分与PICCO所测EVLW及氧合指数的相关性，探讨肺部超声（Lung Ultrasound,LUS）对肺水的监测价值，从而为监测ARDS病人EVLW提供动态有效的方法。方法:在ARDS治疗过程中应用LUS动态监测患者B 线数目，同时应用脉波指示连续心排血法（pulse indicator continuous cardiac output,PICCO）监测血管外肺水指数(extravascular lung water index,EVLWI)作对比，对比B线数目和EVLWI进行Pearson相关行分析。结果:共纳入19例患者，采集171组数据，B线数目与EVLWI呈正相关（r=0.849,p<0.001）。B线数
目与PaO
2/FiO
2
呈高度负相关（r=-0.757,p<0.001）。以PiCCO计算所得EVLWI≧
10ml／kg为阳性，对LUS检测方法绘制ROC曲线，LUS检测的曲线下面积是0.957，敏感度82％，特异度95.3%。结论:B线数目与EVLWI高度正相关，早期使用LUS 对B线的测量能较好诊断肺水增多，且具有高敏感度和特异度。因此，LUS检查是无创、经济、简单、快速、可重复、无放射性的监测ARDS的重要方法。
【关键字】：肺部超声；B线；肺水
Correlation analysis between the number of B line and extravascular lung
water and oxygenation index
【Abstract】
Objective:to evaluate the correlation between B score and EVLW and oxygenation index in patients with ARDS, and to explore the value of lung ultrasound in monitoring the lung water, so as to provide a dynamic and effective method for monitoring PICCO patients with EVLW .Methods: The application of the number of lung ultrasound dynamic monitoring of B line in ARDS patients during the treatment, comparison the application of pulse indicator continuous cardiac blood monitoring EVLWI, Pearson correlation analysis for the number of B lines and EVLWI.Results: A total of 19 patients were enrolled, and the data of the 171 groups were collected. The number of B line was positively correlated with EVLWI (r=0.849, p<0.001). The number of B lines was negatively correlated with
PaO2/FiO2 (r=-0.757, p<0.001). The PiCCO calculated EVLWI = 10ml / kg were
positive on LUS detection method of ROC curve, the 0.957 is the area under the
curve of LUS detection, the sensitivity was 82%, specificity was 95.3%.Conclusions: The number of B line was positively correlated with the height of EVLWI, and the measurement of B line in the early stage of LUS could better diagnose lung water. Therefore, LUS is an important method to monitor ARDS, which is non-invasive, economical, simple, rapid, repeatable and non radioactive.
【Key words】Lung ultrasound;B line;Fluid resuscitation
急性呼吸窘迫综合征（acute respiratory distress syndrome,ARDS）是一种急性、弥漫性的炎症性肺损伤，为常见的呼吸危重症之一。ARDS与血管外肺水（EVLW）的增长密切相关，EVLW指液体积聚在肺间质、细胞内液、肺泡内液等肺血管外组织。EVLW可作为ARDS病人28天死亡率的独立危险因素[1]。而且，很多证据证明在肺水肿病人中EVLW指导治疗能减少死亡率[2]，因此如何精确的计算EVLW对于临床医生处理ARDS的病人有着重要价值[3]。目前临床上常用热稀释法测定EVLW，但为侵入性有创方法。因此需寻找一种操作简便、无创、可重复性强，患者及医生容易接受的方法。此次研究的目的是为了评估ARDS病人的B线评分与PICCO所测EVLW及氧合指数的相关性，探讨LUS对肺水的监测价值，从而为监测ARDS病人EVLW提供动态有效的方法。
1 资料和方法
1.1 一般资料本研究类型为前瞻性、双盲对照研究。收集2014年6月至2016年12月收住本院ICU的19例ARDS患者，其中男性12例，女性7例；年龄65（50，80）岁，平均62岁；APACHE Ⅱ评分21.4±7.1分；机械通气时间8（7，1
2.5）天。本研究符合医学伦理学标准，且经过医院伦理委员会批准，家属知情并签署诊疗知情同意。
1.2 纳入排除标准纳入标准：1.符合柏林指南ARDS的诊断标准
2.机械通气患者。排除标准：1.年龄<18岁2.大量胸腔积液患者
3.严重心脏瓣膜病变
4.气胸患者
5.肺纤维化患者
6.拒绝签署知情同意的患者
7.心脏或肺部外科术后
8.因各