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床旁超声评估急性呼吸衰竭临床应用研究
Usefulness of bedside ultrasound in the management of acute respiratory failure
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DOI:
作者:
贺黉裕,居旻杰,屠国伟,罗哲
He Hongyu, Ju Mingjie, Tu Guowei, Luo Zhe
作者单位:
复旦大学附属中山医院,重症医学科
Department of Anesthesiology and intensive care unit, Zhongshan Hospital, Fudan University.
关键词:
急性呼吸衰竭 床旁超声 诊断
acute respiratory failure; bedside ultrasound; diagnosis
摘要:
目的 评估常规诊断方法联合床旁心肺超声后是否提高急性呼吸衰竭的病因诊断准确率。方法 收集近1年内因呼吸衰竭入重症监护室的成年患者,常规方法根据病史、体检和胸片得出病因诊断。所有患者在入监护室后1小时内行床旁心肺超声检查并得出超声诊断,患者转出重症监护室时根据所有影象学报告、化验结果、病史资料对急性呼吸衰竭给出确切病因诊断。比较常规方法和超声诊断在病因诊断准确率。通过描绘ROC曲线评价床旁超声在急性呼吸衰竭的诊断价值,是否优于常规方法。结果 109名患者入组,其中因肺内因素所致的急性呼吸衰竭占45.9%,心脏因素占17.5%,感染因素占18.3%,其他占18.3%。超声诊断与最终诊断的病因符合率优于常规方法的诊断和最终诊断的符合率(86.2% VS 65.1%,p=0.001)。超声诊断肺相关因素的曲线下面积为0.928,P=0.027,常规方法曲线下面积为0.743,P=0.048。超声诊断心相关因素的曲线下面积为0.957,P=0.032;常规方法为0.814,P=0.066。超声诊断感染相关因素的曲线下面积为0.944,P=0.040,常规方法为0.789,p=0.070。超声诊断其他因素的曲线下面积为0.889 ,P=0.054;常规方法为0.750,p=0.074。结论 超声在诊断肺因素、心脏因素或感染性休克所致的急性呼吸衰竭的特异性和敏感性较高,明显高于常规组。床旁心肺联合超声可提高急性呼吸衰竭病因的准确率,应推荐纳入急性呼吸衰竭患者的诊疗常规。
objective This study investigate the clinical relevance of beside chest ultrasonography and cardiac ultrasound in patients with acute respiratory failure in the ICU. Methods Subjects were patients admitted to the ICU during a 1-year period. Inclusion criteria were age ≥18 years and the presence of acute respiratory failure criteria to justify ICU admission. Routine clinical diagnosis was based on medical history, physical examination and chest radiograph. All the patients underwent beside cardiothoracic ultrasound by intensivists in an hour after admitting intensive care unit. The ultrasound diagnosis were based on the results of scans. The final diagnosis of acute respiratory failure were determined by senior experts from an examination of the complete medical chart when the patients left the intensive care unit. We compared the diagnostic approaches and the final diagnosis. The diagnostic performance of each approach was assessed by calculating the sensitivity, specificity, and diagnostic accuracy with standard formulas. Results one hundred and nine patients were included. Thoracic related cause accounted for 45.9% of all the ARF patients. Cardiac accounted for 17.5%, sepsis accounted for 18.3% and other cause was 18.3%. The ultrasound approach was more accurate than the standard approach (86.2% VS 65.1%,p=0.001). The curve analysis showed greater diagnostic performance of ultrasound in cases of lung disease (ultrasound, 0.928; standard 0.743), cardiac disease (ultrasound 0.957; standard 0.814), sepsis(ultrasound 0.944; standard 0.789) and other disease(ultrasound 0.889; standard 0.750). Conclusions The ultrasound approach had better sensitivity and specificity in diagnosis of ARF cause by lung, cardiac disease or sepsis. The combination of chest and cardiac ultrasound improve the accuracy of ARF diagnosis. Beside ultrasound should be considered as the routine practice in ARF patients.
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