M-BLUE对于急性呼吸衰竭鉴别及病因诊断中的价值

目的探讨急性呼吸衰竭患者采用改良床旁超声(M-BLUE)的诊断学价值。方法选取我院ICU收治的重症患者107例作为研究对象,患者均接受M-BLUE方案、常规床旁超声方案检查,对比两种方案诊断患者的肺部病变膈肌点与胸部CT诊断的一致性、诊断患者合并呼吸衰竭的临床价值;并分析两种方案对于呼吸衰竭患者病因诊断中的差异。结果 107例患者214个膈肌点,以胸部CT检查结果作为判断金标准,结果显示M-BLUE方案诊断膈肌点与胸部CT结果的一致性达到90.19%高于常规床旁超声的72.43%,差异具有统计学意义(P<0.05);以临床最终确诊结果作为判断金标准建立四格表,结果显示M-BLUE方案诊断重症患者合并急性呼吸衰竭的灵敏度为90.91%、特异度为90.48%、漏诊率为9.09%、误诊率为9.52%;常规床旁超声方案诊断重症患者合并急性呼吸衰竭的灵敏度为68.18%、特异度为71.43%、漏诊率为31.82%、误诊率为28.57%;经分析,M-BLUE方案与常规床旁超声方案在诊断重症患者急性呼吸衰竭患者各类单项病因上的差异均无统计学意义(P>0.05);但是,M-BLUE方案整体上诊断急性呼吸衰竭病因的准确率达到90.91%高于常规床旁超声的68.18%,差异具有统计学意义(P<0.05)。结论 M-BLUE方案对于重症患者膈肌点的判断更加准确、对于急性呼吸衰竭的诊断价值更高、同时有利于明确诊断患者发生急性呼吸衰竭的病因。

Value of M-BLUE in the differential diagnosis and etiology diagnosis of acute respiratory failure

Objective To investigate the diagnostic value of modified bedside ultrasound(M-BLUE) in patients with acute respiratory failure. Methods 107 critically ill patients admitted to our hospital were selected as the study subjects. All patients underwent M-BLUE and routine bedside ultrasound. The consistency and diagnosis of pulmonary lesions and chest CT were compared between the two methods. The clinical value of patients with respiratory failure and the differences in the etiology of the two regimens were analyzed for patients with respiratory failure. Results 107 patients were with 214 diaphragm points. Taking the results of chest CT examination as the gold standard, the results showed that the consistence of M-BLUE program and chest CT in diagnosis of the diaphragm point reached 90.19%, which was higher than 72.43% of the conventional bedside ultrasound(P<0.05). The four-table was established by using the final clinical diagnosis as the gold standard. The results showed that the sensitivity of the M-BLUE program for the diagnosis of severe respiratory failure was 90.91%, the specificity was 90.48%, the missed diagnosis rate was 9.09%, and the misdiagnosed rate was 9.52%. The sensitivity of routine bedside ultrasound in the diagnosis of severe respiratory failure was 68.18%, the specificity was 71.43%, the missed diagnosis rate was 31.82%, and the misdiagnosed rate was 28.57%. Through analysis, there was no significant difference in the etiology of M-BLUE and conventional bedside ultrasound in the diagnosis of acute respiratory failure in severely ill patients(P>0.05). However, the accuracy of M-BLUE in the overall diagnosis of acute respiratory failure reached90. 91%,which was obviously higher than 68. 18% of conventional bedside ultrasound( P < 0. 05). Conclusion The M-BLUE program is more accurate for the diagnosis of diaphragmatic points in critically ill patients,which has a higher diagnostic value for acute respiratory failure,and is conducive to the definitive diagnosis of the cause of acute respiratory failure in patients.