床旁肺部超声评估新型冠状病毒肺炎患者肺损伤的价值

目的探讨床旁肺部超声在评估新型冠状病毒肺炎（COVID-19）患者肺损伤中的价值。 方法对深圳市第三人民医院2020年1月至3月共74例经核酸检测确诊为COVID-19的患者进行床旁肺部超声检查,根据国家卫生健康委办公厅《新型冠状病毒感染的肺炎诊疗方案（试行第七版）》临床诊断方法分为危重症组（n=15）、重症组（n=22）及轻症组（含普通型;n=37）,记录超声检查当天患者的氧合指数、辅助通气情况、肺部声像图特征等信息,并计算肺积分。采用单因素方差分析3组氧合指数、辅助通气天数和肺积分的差异。采用Pearson χ²检验比较3组肺部声像图特征的差异,不同特征构成比采用独立样本秩和检验。采用Pearson双变量方法分析肺积分与氧合指数、辅助呼吸天数的相关性。 结果危重症组、重症组及轻症组氧合指数比较［（220.96±104.65）mmHg vs（296.00±78.95）mmHg vs（393.78±118.97）mmHg;1 mmHg=0.133 kPa］,差异具有统计学意义（F=18.520,P＜0.001）;辅助通气天数比较［（19.27±11.91）d vs（8.77±6.73）d vs（2.92±5.43）d］,差异具有统计学意义（F=25.483,P＜0.001）;肺积分比较［（20.6±4.98）分vs（12.77±5.54）分vs（4.54±3.43）分］,差异具有统计学意义（F=73.894,P＜0.001）。危重症组肺部声像图的主要表现为胸膜增厚不连续（100%,15/15）、大实变（80%,12/15）和心包积液（13%,2/15）,其中大实变和心包积液与重症组、轻症组比较,差异均有统计学意义（与重症组比较：80%（12/15）vs 32%（7/22）,Z=3.170,P=0.005;13%（2/15）vs 0,Z=2.439,P=0.044;与轻症组比较：80%（12/15）vs 5%（2/22）,Z=5.369,P＜0.001;13%（2/15）vs 0,Z=2.668,P=0.023）。肺积分与氧合指数呈负相关（r=-0.62,P＜0.01）,与辅助呼吸天数呈正相关（r=0.67,P＜0.01）。 结论床旁肺部超声可以辅助评估COVID-19患者肺损伤的程度,可对临床诊疗提供帮助。     

改良肺部超声检查法对新型冠状病毒肺炎痊愈患者肺部损害的随访评估

目的:评估改良肺部超声检查法对新型冠状病毒肺炎(corona virus disease 2019,COVID-19)痊愈患者肺部损害的随访作用。方法:随机选取2020年1-5月泉州市第一医院22例COVID-19痊愈患者,按照入院首次高分辨率CT(high resolution CT,HRCT)检查分为轻度7例、中度...     

细胞因子风暴在2019新型冠状病毒肺炎肺损伤中的作用

2019新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)是一种以肺为主要靶器官的全身多器官损伤性疾病。细胞因子风暴在COVID-19患者肺损伤中发挥重要作用,严重急性呼吸窘迫综合征冠状病毒-2靶向血管紧张素转换酶2(angiotensin-converting enzyme 2,ACE2)感染肺部的细胞,并引起以活化的巨噬细胞、中性粒细胞和T细胞为主的复杂免疫反应,这些细胞和受感染的细胞可在短时间内分泌大量的炎症因子,同时,炎症因子又可趋化更多的炎症细胞参与肺损伤过程,从而放大炎症效应造成肺的免疫损伤,此外,细胞因子风暴介导的其他器官损伤也可能对肺造成影响。本文总结了肺内细胞因子风暴的发生机制,并就炎症细胞[巨噬细胞(M1型与M2型巨噬细胞)、中性粒细胞和效应T细胞(辅助性T细胞17)]、细胞因子[白细胞介素(interleukin,IL)(IL-2,IL-17,IL-6,IL-1β)、肿瘤坏死因子(tumor necrosis factor,TNF)(TNF-α)、集落刺激因子(粒细胞集落刺激因子与粒细胞巨噬细胞集落刺激因子)]和趋化因子(干扰素-γ诱导蛋白10与巨噬细胞炎性蛋白1a)在COVID-19患者肺损伤的作用以及细胞因子风暴引发的肾衰竭和心脏损伤对肺的影响进行综述。     

肺部超声在新型冠状病毒肺炎中的应用研究进展

本文分别就新型冠状病毒肺炎(COVID-19)、肺部超声及其在COVID-19中的应用进行简要阐述,旨在评估肺部超声在COVID-19中的应用价值,以期为临床上应用肺部超声筛查、诊断和评估COV-ID-19病情提供有价值的信息.     

高分辨CT定量分析评估新型冠状病毒肺炎临床分型及转归的价值

目的:探讨高分辨CT定量评分对新型冠状病毒肺炎(novel coronavirus pneumonia,NCP)临床分型及临床治愈转归评估的应用价值.资料与方法:回顾性分析符合该病临床诊断的30例NCP的胸部CT图像,对普通组、重型组、危重组、临床治愈转归组肺部渗出性病变进行CT定量范围、密度及两者综合评分,对各组间进...     

新型冠状病毒肺炎CT早期征象再认识

目的分析新型冠状病毒肺炎CT早期典型征象及有价值的阴性征象,达到快速筛查、精准诊断及指导临床早期处理的目的。方法回顾性分析国内7家医院收治、核酸确诊阳性、有早期CT影像改变的115例新型冠状病毒肺炎临床资料,男68例,女47例;平均年龄(46.7±17.4)岁。结果.115例患者中,26例单肺发病,89例双肺发病。35例可见空气支气管征,28例可见血管增粗征,24例可见病灶周围晕征,4例纵隔淋巴结肿大,2例可见局限性胸膜增厚,均未见支气管壁增厚征、树芽征、胸腔积液。肺内共发现1071个病变,980个病灶累及≥3肺叶,696个病灶沿着胸膜下分布,575个病灶沿支气管血管束分布,753个病灶呈类圆形/楔形状,794个病灶为磨玻璃密度、277个病灶为实性或部分实性,254呈铺路石征改变。结论新型冠状病毒肺炎CT早期征象复杂多样,除典型征象外,部分少见、阴性征象同样有助于快速识别。     

肺部超声对重症监护病房中新型冠状病毒肺炎的应用价值

目的观察肺部超声在重症监护病房（ICU）接受治疗的新型冠状病毒肺炎（COVID-19）患者中的应用价值。 方法回顾分析2020年2月20日至3月19日武汉雷神山医院B2病区ICU收治的50例COVID-19患者的临床资料。患者在入ICU时均接受肺部CT及肺部超声检查,记录相关数据：APACHE Ⅱ评分、C反应蛋白、白介素6、静态肺顺应性、氧合指数、肺部超声评分,并将CT与超声图像进行对比。记录患者入ICU后28 d内存活情况及存活患者的ICU住院天数。 结果患者的肺部超声评分与APACHEⅡ评分、C反应蛋白、白介素6呈正相关,与静态肺顺应性、氧合指数呈负相关（P均<0.01）;以肺部CT图像为金标准,肺部超声诊断肺部疾病的准确性为90.3%（542/600）、敏感度为87.1%（316/363）、特异度为95.3%（226/237）;入ICU 28 d存活患者的肺部超声评分与ICU治疗时间呈正相关（P<0.01）。 结论肺部超声应用在ICU治疗的COVID-19患者中,与肺部CT一致性高,能有效评估患者的严重程度、炎症状态、肺部顺应性及预测患者预后,可作为在ICU治疗的COVID-19患者的必要监测方法。     

新型冠状病毒肺炎隔离病房床旁超声检查的实践与总结

目的探讨床旁超声在新型冠状病毒肺炎(以下简称新冠肺炎)隔离病房内的应用价值及实施方法。方法统计分析2020年2～3月同济医院光谷院区新冠肺炎隔离病房内床旁超声的检查项目、数量、时间、诊断、防护方法及具体实施策略。结果共完成450人次床旁超声检查。超声医师平均每天进入隔离病房2.3次,每次耗时2.9 h。主要阳性发现为心脏异常、深静脉血栓、腹部脏器异常及腹水等。在二级及三级防护条件下,床旁超声检查的医护人员均未出现新型冠状病毒感染。结论床旁超声在新冠肺炎的诊疗过程中发挥重要作用,但实施难度加大、感染风险高,需不断总结实践经验,制定安全、高效的实施策略。     

重症新型冠状病毒肺炎患者床旁超声诊治1例报告

虽然肺部CT对肺炎诊断具有优势,但对重型新型冠状病毒肺炎(COVID-19)患者临床应用面临交叉感染、加重病情等风险.本研究探讨床旁超声对重型COVID-19患者应用的特点,评价其临床诊断与治疗的作用.实践证明,超声有助于快速筛查COVID-19患者呼吸衰竭病因,在诊治、抢救过程中发挥重要作用.     

超声评估爆炸性肺损伤的研究进展

爆炸性肺损伤常发生于军事斗争、恐怖袭击和爆炸性损伤中,快速、准确地诊断爆炸性肺损伤对救治工作的开展实施极为重要。近年来,超声在肺损伤诊断中发挥着越来越重要的作用,研究结果主要包括:①B线增减程度与肺损伤的严重程度呈正相关;②肺内含气或含液管状结构是诊断肺实变的重要特征;③胸腔内无回声区是诊断胸腔积液的重要特征。利用肺超声的特点可以对爆炸所致肺损伤的严重程度进行早期快速、有效的评估。本文就超声评估爆破性肺损伤的研究进展进行综述。     

Lung Ultrasound in Children with COVID-19: Preliminary Findings

Recent evidence indicates the usefulness of lung ultrasound (LUS) in detecting coronavirus disease 19 (COVID-19) pneumonia. However, no data are available on the use of LUS in children with COVID-19 pneumonia. In this report, we describe LUS features of 10 consecutively admitted children with COVID-19 in two tertiary-level pediatric hospitals in Rome. LUS revealed signs of lung involvement during COVID-19 infection. In particular, vertical artifacts (70%), pleural irregularities (60%), areas of white lung (10%) and subpleural consolidations (10%) were the main findings in patients with COVID-19. No cases of pleural effusions were found. According to our experience, the routine use of LUS in the evaluation of children with suspected or confirmed COVID-19, when performed by clinicians with documented experience in LUS, was useful in diagnosing and monitoring pediatric COVID-19 pneumonia, reducing unnecessary radiation/sedation in children and exposure of health care workers to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).     

Lung Assessment with Point-of-Care Ultrasound in Respiratory Coronavirus Disease (COVID-19): A Prospective Cohort Study

Lung ultrasound (LUS) has shown promising diagnostic potential in different pulmonary conditions. We evaluated the diagnostic accuracy of LUS for pulmonary COVID-19. In this prospective cohort study at a Swiss tertiary care center, patients hospitalized with suspected COVID-19 were scanned using a 12-zone protocol. Association of a summation score (0–36 points) with the final diagnosis was tested using the area under the receiver operating characteristic curve and sensitivity and specificity at different cutoff points. Of the 49 participants, 11 (22%) were later diagnosed with COVID-19. LUS score showed excellent diagnostic performance, with an odds ratio of 1.30 per point (95% confidence interval [CI], 1.09–1.54, p = 0.003) and an area under the curve of 0.85 (95% CI, 0.71–0.99). At a cutoff of 8/36 points, 10 of 11 participants later diagnosed with COVID-19 were correctly predicted (sensitivity 91%, 95% CI, 59%–100%), and 29 of the 38 who were not diagnosed with COVID-19 were correctly ruled out (specificity 76%, 95% CI, 60%–89%). LUS demonstrated promising discriminatory potential in people hospitalized with suspected COVID-19.     

Lung Ultrasound May Support Diagnosis and Monitoring of COVID-19 Pneumonia

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) is characterized by severe pneumonia and/or acute respiratory distress syndrome in about 20% of infected patients. Computed tomography (CT) is the routine imaging technique for diagnosis and monitoring of COVID-19 pneumonia. Chest CT has high sensitivity for diagnosis of COVID-19, but is not universally available, requires an infected or unstable patient to be moved to the radiology unit with potential exposure of several people, necessitates proper sanification of the CT room after use and is underutilized in children and pregnant women because of concerns over radiation exposure. The increasing frequency of confirmed COVID-19 cases is striking, and new sensitive diagnostic tools are needed to guide clinical practice. Lung ultrasound (LUS) is an emerging non-invasive bedside technique that is used to diagnose interstitial lung syndrome through evaluation and quantitation of the number of B-lines, pleural irregularities and nodules or consolidations. In patients with COVID-19 pneumonia, LUS reveals a typical pattern of diffuse interstitial lung syndrome, characterized by multiple or confluent bilateral B-lines with spared areas, thickening of the pleural line with pleural line irregularity and peripheral consolidations. LUS has been found to be a promising tool for the diagnosis of COVID-19 pneumonia, and LUS findings correlate fairly with those of chest CT scan. Compared with CT, LUS has several other advantages, such as lack of exposure to radiation, bedside repeatability during follow-up, low cost and easier application in low-resource settings. Consequently, LUS may decrease utilization of conventional diagnostic imaging resources (CT scan and chest X-ray). LUS may help in early diagnosis, therapeutic decisions and follow-up monitoring of COVID-19 pneumonia, particularly in the critical care setting and in pregnant women, children and patients in areas with high rates of community transmission.     

Utility of Point-of-Care Lung Ultrasound for Clinical Classification of COVID-19

In this study, the utility of point-of-care lung ultrasound for clinical classification of coronavirus disease (COVID-19) was prospectively assessed. Twenty-seven adult patients with COVID-19 underwent bedside lung ultrasonography (LUS) examinations three times each within the first 2 wk of admission to the isolation ward. We divided the 81 exams into three groups (moderate, severe and critically ill). Lung scores were calculated as the sum of points. A rank sum test and bivariate correlation analysis were carried out to determine the correlation between LUS on admission and clinical classification of COVID-19. There were dramatic differences in LUS (p < 0.001) among the three groups, and LUS scores (r = 0.754) correlated positively with clinical severity (p < 0.01). In addition, moderate, severe and critically ill patients were more likely to have low (≤9), medium (9–15) and high scores (≥15), respectively. This study provides stratification criteria of LUS scores to assist in quantitatively evaluating COVID-19 patients.     

Vaping-Associated Lung Injury During COVID-19 Multisystem Inflammatory Syndrome Outbreak

BackgroundE-cigarette or vaping product use–associated lung injury (EVALI) is a complex inflammatory syndrome predominantly seen in adolescents and young adults. The clinical and laboratory profile can easily mimic infectious and noninfectious conditions. The exclusion of these conditions is essential to establish the diagnosis. Recently, the novel coronavirus disease 2019 (COVID-19) pandemic introduced the multisystem inflammatory syndrome in children (MIS-C). MIS-C knowledge is evolving. The current criteria to establish the diagnosis are not specific and have overlapping features with EVALI, making the accurate diagnosis a clinical challenge during continued COVID-19 transmission within the community.Case ReportThree young adults evaluated at our emergency department for prolonged fever and gastrointestinal and respiratory symptoms were initially assessed for possible MIS-C due to epidemiologic links to COVID-19 and were eventually diagnosed with EVALI. The clinical, laboratory, and radiologic characteristics of both entities are explored, as well as the appropriate medical management.Why Should an Emergency Physician Be Aware of This?Physician awareness of overlapping and differentiating EVALI and MIS-C features is essential to direct appropriate diagnostic evaluation and medical management of adolescents and young adults presenting with systemic inflammatory response during the unfolding pandemic of COVID-19.     

Lung Ultrasound Can Predict the Clinical Course and Severity of COVID-19 Disease

Coronavirus disease 2019 (COVID-19) compromises the lung in large numbers of people. The development of minimally invasive methods to determine the severity of pulmonary extension is desired. This study aimed to describe the characteristics of sequential lung ultrasound and to test the prognostic usefulness of this exam in a group of patients admitted to the hospital with COVID-19. We prospectively evaluated patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection admitted to our hospital between April and August 2020. Bedside lung ultrasound exams were performed at three time points: at inclusion in the study, after 48 h and on the seventh day of follow-up. Lung ultrasound scores were quantified according to the aeration loss in each of eight zones scanned. Sixty-six participants were included: 42 (63.6%) in the intensive care unit and 24 (36.3%) in the ward. Lung ultrasound scores were higher in participants admitted to the intensive care unit than in those admitted to the ward at the time of inclusion (16 [13–17] vs. 10 [4–14], p < 0.001), after 48 h (15.5 [13–17] vs. 12.5 [8.2–14.7], p = 0.001) and on the seventh day (16 [14–17] vs. 7 [4.5–13.7], p < 0.001) respectively. Lung ultrasound score measured at the time of inclusion in the study was independently associated with the need for admission to the intensive care unit (odds ratio = 1.480; 95% confidence interval, 1.093–2.004; p = 0.011) adjusted by the Sequential Organ Failure Assessment score.