超声对肺外周及胸膜转移癌的早期诊断

目的 探讨超声对肺外周及胸膜≤2cm转移癌的诊断价值及声像图特征。方法 对中晚期肺、乳腺及消化系等恶性肿瘤患者行肋间及肋缘下肺底扫查,观察肺外周及胸膜下≤2cm小转移癌声像图特征及诊断率。结果 经确诊小转移癌61例中,超声显示56例（91.8%）,其中约半现灶≤1cm。声像图表现多呈类圆形（83.9%）,边界清晰规整（73.2%）,内部呈均匀的弱回声或无回声（78.6%）,局部胸膜不清晰或中断（75％),后方显示典型的长“彗星尾征”（89.3%）。根据以上特征,25例（44.6%）在未知X线、CT、临床诊断结果情况下超声作出诊断,其中6例为超声首诊。超声对检出的病灶定性诊断较X线、CT敏感,但易漏诊,肩胛骨、肋骨、肺气体等为主要影响因素。结论 对于肺周及胸膜下的转移癌,超声检查不受肺气体干扰,显示率较高,声像图典型,尤其后方长“彗星尾征”为敏感的超声指征。超声作为X线、CT的辅助诊断手段,有助于提高肺周转移癌的早期诊断率。     

COVID-19患者肺超声与CT影像相关性研究

目的 探讨新型冠状病毒肺炎患者肺超声与CT影像相关性，肺超声对COVID-19患者肺部病变评估的作用。 方法 超声医师采用单侧六分区法对25例COVID-19患者进行床旁肺超声顺序盲扫，观察每个肺区胸膜线厚度、形态、完整性，胸膜滑动征，A线，B线的分布、数目、融合范围，肺实变位置、内部回声、范围，是否有胸腔积液等伴随征象。行半定量评分，与同期胸部CT影像对照，应用SPSS24. 0统计学软件分析右肺、左肺、全肺超声评分与CT病灶体积占比相关性。比较普通型、（危）重型患者全肺超声评分、CT病灶体积占比。 结果 全肺总评分最低为0分（1例），最高为22（1例）。患者右肺、左肺超声评分比较差异有统计学意义（P<0.05），R1-R6、L1-L6区评分比较差异有统计学意义（均P<0.05）。右肺、左肺、全肺超声评分与CT病灶体积占比相关系数分别为0.942、0.956、0.922（均P<0.01）。全肺超声评分普通型[5（4.25）]与（危）重型[14（9.5）]比较；全肺CT病灶体积占比普通型[4.3（6.85）%]与（危）重型[22.4（20.25）%]比较，差异均有统计学意义（均P<0.01）。COVID-19患者肺超声评分与CT病灶体积占比具有显著相关性。 结论 以CT为参照，床旁肺超声对COVID-19患者肺部病变的无创性评估具有重要意义。     

肺超声评分在预测新生儿呼吸窘迫综合征合并支气管肺发育不良中的临床价值

目的：探讨肺超声评分预测新生儿发生呼吸窘迫综合征（NRDS）合并支气管肺发育不良（BPD）的临床价值。 方法：对158例NRDS患儿进行肺部超声检查,根据标准计算肺超声评分,并收集患儿一般临床资料。依据是否合并支气管肺发育不良（BPD）将其分为BPD组和非BPD组,对比两组患儿肺超声评分及临床资料的差异。分析肺超声评分预测NRDS合并BPD临床价值,并探讨肺超声评分与不同治疗方式之间的相关性。 结果：BPD组肺超声评分高于非BPD组 （P＜0.001）。两组患儿在胎龄、出生体重中均有差异（P＜0.05）。住院时长、持续气道正压呼吸及机械通气时间、Apgar评分这些因素中两组也均有差异（P＜0.05）。两组间性别、双胎数、常规氧疗时间,以及宫内感染、新生儿肺炎发生率差异无统计学意义 （P＞0.05）。肺超声评分预测BPD的ROC曲线下面积为0.832,最佳评分临界值37分,敏感度78%,特异度89%,阳性预测值86.7%,阴性预测值74.5%。患儿肺超声评分与采用的呼吸治疗方式之间呈正相关（r=0.47,P＜0.05）。 结论：肺超声评分法有助于预测NRDS患儿是否合并BPD,为重症患儿的呼吸治疗方式提供一定依据。     

彩色多普勒超声诊断小儿肠套叠

目的 探讨彩色多普勒超声（CDFI）对小儿肠套叠的诊断及辅助临床选择复位方式的价值。方法 回顾分析90例经CDFI诊断,并经X线空气灌肠复位或手术复位小儿肠套叠资料。结果 经X线空气灌肠复位成功79例（87．8％）,10例行手术治疗（11％）后复位成功,超声误诊1例,超声确诊率98．8％。肠壁严重水肿,阻力指数（RI）显著升高,无血流显示等情况时禁忌空气灌肠,应尽快手术复位。结论CDFI对小儿肠套叠的诊断符合率高,可作为影像学首选的检查方法,并且对临床选择肠套叠复位方式有一定的价值。     

肺实变的超声特征及其诊断价值

目的探讨肺实变的超声特征及其诊断价值。方法对125例实变肺的二维及彩色多普勒超声表现进行回顾性对比分析。结果含气或含液管状结构以及分支状血流信号是超声诊断肺实变的重要特征。彩色多普勒超声显示实变肺内血流信号有较高敏感性（92．7％），对含气或含液管状结构和肿块的检出率也高于灰阶超声，差异有显著性（P〈0．05）。超声在确定肺实变方面优于X-线检查（P〈0．005），与CT相比差异无显著性（P〉0．05）。结论彩色多普勒超声在肺实变的诊断中优于灰阶超声，是对X-线、CT等其他影像方法的一个很好补充。     

三维超声在膈疝胎儿肺容积测量中的应用

目的：评价三维超声测量先天性膈疝（Congenital diaphragmatic hernia, CDH）胎儿肺容积的准确性,并初步探讨CDH胎儿肺容积改变规律。方法：对10例拟引产的CDH胎儿于引产前1~3d应用三维超声体积自动测量技术（Virtual organ computer-aided analysis, VOCAL）测得其肺容积值,引产后6h内对胎儿进行病检,用水置换法得到其实际容积。同时测量150例正常对照组胎儿肺容积,并与CDH胎儿进行统计学比较。结果：①三维超声测量CDH胎儿肺容积与病检结果间有较好的相关性,相关系数（r）为0.79,偏倚及95%一致性界限分别为0.68cm3及（－4.59~3.24）cm3;②CDH胎儿肺容积较同孕周对照组明显减小。结论：先天性膈疝时胎儿肺脏受压体积明显缩小;三维超声测量CDH胎儿肺容积的准确性较好,可能成为评估其肺发育不良程度的重要方法。     

三维超声体积自动测量技术评估肺血减少型先天性心脏病胎儿肺体积变化

目的 采用三维超声计算机辅助虚拟脏器分析（VOCAL）技术观察肺血减少型先天性心脏病（CHD-DPBF）对胎儿肺体积发育的影响。方法 收集41胎法洛四联症（TOF）胎儿（TOF组）和110胎正常胎儿（对照组），以二维超声估测胎儿孕周、体质量及心胸比（CTR），以三维超声VOCAL技术测量胎儿肺体积，计算超声肺重比（肺体积与体质量的比值）和肺体积与孕周比值，比较2组间的差异；评估胎儿肺体积与孕周的相关性。结果 TOF组胎儿孕周、估算体质量和肺体积与对照组比较差异无统计学意义（P均>0.05），TOF组胎儿CTR大于对照组（P<0.001），胎儿肺体积与孕周比值及超声肺重比小于对照组（P均<0.05）。TOF组及对照组胎儿肺体积与孕周均呈正相关（r=0.611、0.547，P均<0.001）。结论 CHD-DPBF胎儿超声肺重比及肺体积与孕周比值均低于正常胎儿，提示CHD-DPBF胎儿肺脏发育受到一定程度不良影响。     

超声多普勒参数主肺动脉加速时间与射血时间比值对妊娠糖尿病孕妇胎儿肺成熟度评估的价值研究

目的：研究超声多普勒参数主肺动脉加速时间与射血时间比值对妊娠糖尿病孕妇胎儿肺成熟度评估的价值。方法：选取2020年1月—2021年12月期间佛山市妇幼保健院收治的妊娠糖尿病37周后待产孕妇,共计500例,以分娩后胎儿肺成熟度情况,分为胎儿肺成熟组及胎儿肺非成熟组。对所有产妇均采用彩色多普勒超声诊断仪进行检查,期间记录胎儿主肺动脉中段的加速时间（AT）、射血时间（ET）,分析AT/ET值对新生儿肺成熟度的预测价值。结果：胎儿肺非成熟组AT/ET值低于胎儿肺成熟组（P <0.05）;ROC曲线显示,胎儿主肺动脉中段AT/ET预测新生儿肺成熟度的最佳截断值为0.218时,灵敏度为97.44%,特异度为99.76%,准确率为99.40%,AUC为0.908。通过一致性检验（Kappa检验）分析,AT/ET值预测妊娠糖尿病患者新生儿肺成熟度的效能较高（Kappa值=0.846,P <0.05）。结论：通过超声多普勒参数AT/ET值对妊娠糖尿病孕妇胎儿肺成熟度评估时,能够为临床提供有价值的信息,对新生儿肺成熟度评估有一定预测价值。     

心脏、肺和膈肌超声联合预测重症机械通气患者撤机的价值

目的 探讨心脏、肺和膈肌超声联合预测重症机械通气患者撤机的价值。方法 选取我院重症医学科接受机械通气>48 h并符合撤机条件患者112例,根据患者撤机后48 h呼吸状况分为成功撤机者64例（撤机成功组）和撤机失败者48例（撤机失败组）,两组均于自主呼吸试验（SBT）开始时（0 min）采用床旁超声测量左室射血分数（LVEF）、左室短轴缩短率（LVFS）、二尖瓣舒张早期血流峰值速度（E）、二尖瓣环室间隔和左室侧壁舒张期组织运动峰值速度平均值（e’）,并计算E/e’。使用肺超声经胸壁扫查肺部,并分别于SBT 0 min、15 min时计算胸前区肺超声水肿评分（A-LUES0 min和A-LUES15 min）及二者差值（ΔA-LUES）。于SBT 15 min时测量膈肌移动度（DE）及膈肌收缩速度（DCV）。绘制受试者工作特征曲线分析各超声参数预测撤机的价值。结果 撤机失败组LVEF、DE、e’均明显低于撤机成功组,E/e’、A-LUES15 min、ΔA-LUES均明显高于撤机成功组,差异均有统计学意义（均P<0.05）;两组A-LUES0 min、DCV、LVFS、E比较差...     

超声造影在经皮肺周围型肿物活检的应用价值

目的：探讨超声造影在经皮肺周围型肿物活检的应用价值。方法：选取2018年6月至2019年12月就诊于我院的肺周围型肿物患者60例进行回顾分析。结果：良恶性肺周围型肿物的超声造影增强方式差异P=0.771,良恶性肿物的超声造影到达时间差异P=0.001。实验组与对照组肋间血管显示率为28/30（93.33%）、24/30（80%）,穿刺并发症发生率1/30（3.33%）、5/30（16.67%）,病理诊断率30/30（100%）、26/30（86.67%）。结论：超声造影提供了病灶组织结构及血流灌注信息,联合超声造影应用于经皮肺肿物活检术可以提高穿刺准确率。     

Bedside assessment of extravascular lung water by dilution methods: temptations and pitfalls

OBJECTIVES: To review the advantages and limitations of dilution methods to assess extravascular lung water (EVLW) at the bedside and to discuss the clinical value of EVLW measurements. DATA SOURCE: Experimental and clinical studies were searched in PUBMED by using "extravascular lung water" and "dilution method" as keywords and further selected as studies investigating either the reliability or the clinical usefulness of dilution methods to assess EVLW. Related articles and the reference lists of selected studies were scanned for additional relevant references. CONCLUSIONS: Both the double-indicator (thermo-dye) dilution and the single-indicator (cold saline) dilution methods showed close agreement with gravimetric measurement of EVLW (the reference ex vivo method) and have the advantage of being available at the bedside. Most limitations of dilution methods have been described in experimental conditions and lead to an underestimation of EVLW. These limitations include large pulmonary vascular obstruction, focal lung injury, and lung resection. Dilution methods provide an easy and clinically acceptable estimation of EVLW in most critically ill patients, including those with acute respiratory distress syndrome (ARDS). Assessing EVLW may be useful to predict outcome, to diagnose pulmonary edema, to better characterize patients with ARDS, to guide fluid therapy, and to assess the value of new treatments or ventilatory strategies in patients with pulmonary edema.     

床旁肺部超声对ICU急性呼吸窘迫综合征的临床价值

目的：探讨床旁肺部超声(LUS)对ICU急性呼吸窘迫综合征(ARDS)的临床价值。方法：将60例疑似ARDS患者分别进行血气分析、胸部CT以及LUS检查,确诊ARDS40例,分析LUS诊断ARDS的敏感度、特异性及准确率,以LUS评分=18分为截断值,绘制LUS诊断ARDS的ROC曲线,并计算曲线下面积。根据“柏林标准”将ARDS患者分为A组(非重度)、B组(重度)两组,比较两组患者的LUS评分、EVLW以及APACHE II评分,并做相关性分析。根据预后将患者分为C组(死亡)与D组(生存),记录并比较两组的LUS评分、EVLW以及APACHE II评分。结果：LUS诊断ARDS的敏感度,特异性及准确率分别87.5%,75.0%及83.3%,曲线下面积是0.957,标准误是0.014,可信区间是0.029~0.985。重度组LUS评分、EVLW以及APACHE II评分明显高于非重度组 (P<0.05), LUS结果与EVLW数值呈正相关(r= 0.763,P<0.05),LUS结果与APACHE II评分呈正相关(r= 0.593 ,P<0.05)。死亡组LUS评分、EVLW数值及APACHE II评分均明显高于生存组 (P均<0.05)。结论：LUS可以准确诊断ARDS、判断病情并评估预后,具有良好的临床价值。     

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.     

肺超声联合超声弹性成像技术评价结缔组织病相关间质性肺疾病研究进展

结缔组织病相关间质性肺病（CTD-ILD）发病率和死亡率均高，早发现、早治疗是控制CTD-ILD进展的关键。目前，肺超声（LUS）及超声弹性成像（UE）用于临床评估CTD-ILD，其中常规灰阶超声可观察B线、胸膜不规则等异常改变，UE可发现肺表面组织的弹性改变。本文对LUS及UE在CTD-ILD中的应用价值及研究进展进行综述。     

儿童肺部超声检查的临床应用

呼吸系统疾病传统影像学检查方法主要依赖X线和CT。随着超声对肺部疾病应用的推广、诊断水平的提高以及人们对儿童放射性辐射损伤的重视,近年来肺超声检查逐渐得到临床医生的认可,目前已成功应用于儿童肺疾病的辅助诊断、治疗中监测及效果评估。笔者主要从儿童肺超声的检查方法及在肺疾病等方面的应用进行介绍。     

促红细胞生成素在急性肺损伤与急性呼吸窘迫综合征中作用的研究进展

急性肺损伤（ALI）或急性呼吸窘迫综合征（ARDS）是临床常见急危重症。各种病因包括严重感染、创伤、休克、急性胰腺炎、肺炎等肺内或肺外因素均可导致ALI/ARDS,发病机制主要包括炎症反应、细胞凋亡、氧化应激和肺泡毛细血管膜的损害等,目前尚无特殊有效的治疗方法,临床上也无修复肺损伤的有效药物。促红细胞生成素（EPO）作为一种多功能的内源性调节因子对各种组织损伤有一定的细胞保护作用,尤其是肺组织〔1〕,成为治疗ALI/ARDS的研究热点,     

肺部超声在ICU中的综合应用进展

近年来随着肺部超声技术的进一步发展,在重症监护中可对危重患者进行无创的可重复操作的病情诊断及监测。且在诊断肺部疾病时具有较高的灵敏度和特异度,可对重症患者进行实时监控病情变化,评估治疗效果,肺部超声具有较高的诊断价值。     

Sonographic Interstitial Syndrome

Objective. Ultrasound lung comets (ULCs) now have an acknowledged correlation with extravascular lung water, but they present in different orders and numbers in different pathologic pulmonary entities. How these artifacts are created is not yet known, and the literature gives discordant hypotheses. Understanding their formation is the first step in understanding lung disease. The purpose of this study was to show the morphologic and genetic variability of interstitial lung disease studied with echography and thus to propose a unitary mechanism for the formation of ULCs. Methods. This study included 3 parts: (1) a retrospective analysis of echographic lung images of patients with interstitial syndrome; (2) an analysis of the literature for definitions of the size of the pulmonary lobule; and (3) an experimental model of different air‐water interfaces scanned with varying ultrasonic frequencies. Results. The retrospective analysis of echographic lung images included 176 patients with diffuse ULCs: 118 patients had acute pulmonary edema; 18 had acute lung injury/acute respiratory distress syndrome; and 40 were premature neonates with respiratory distress syndrome. Experimental models permitted us to discover that ring‐down artifacts are produced only by single and double layers of bubbles in specific structural settings. Conclusions. Reverberation between bubbles with a critical radius seems to be at the origin of ring‐down artifacts. Echographic manifestations of interstitial lung disease, whose genesis lies in the partial air loss of lobes and segments, are acoustic phenomena originating from variations in the tissue‐fluid relationship of the lung. A correlation between anatomopathologic characteristics and structures of sonographic artifacts could allow more rapid and noninvasive diagnoses.     

Assessing Extravascular Lung Water in Critically Ill Patients Using Lung Ultrasound: A Systematic Review on Methodological Aspects in Diagnostic Accuracy Studies

Lung ultrasound (LUS) is a non-invasive bedside method used to quantify extravascular lung water (EVLW). To evaluate the methodology and diagnostic accuracy of LUS in studies assessing EVLW in intensive care unit patients, PubMed and Embase were searched for studies comparing LUS with imaging modalities. In 14 relevant studies a wide variety of equipment used and training of examiners were noted. Four scoring systems were reported: (i) a binary score (the presence of three or more B-lines); (ii) a categorical score; (iii) a numerical score; (iv) a quantitative LUS score using software. The diagnostic accuracy of LUS varied: sensitivity ranged from 50%–98%, specificity from 76%–100% and r² from 0.20–0.91. Methodology and diagnostic accuracy varies substantially in published reports. Further research is needed to correlate methodological factors with diagnostic accuracy. Hospitals should standardize LUS methodology. Consensus is needed to harmonize LUS methodology for lung water assessment.     

In vivo validation of the thermal-green dye technique for measuring extravascular lung water

Assessment of extravascular lung water (EVLW) is imprecise in vivo, yet of both clinical and investigative relevance in patients with cardiac disease. Recently, a double-indicator method using thermal-green dye has been proposed as a nondestructive technique for in vivo quantification of EVLW. In our 5-yr study, indocyanine green dye was used as the intravascular indicator and heat as the diffusible indicator in 44 control dogs, 74 dogs administered intravenous oleic acid, 63 dogs in whom left atrial pressure was altered with a left atrial balloon, and 31 dogs with low-output cardiac failure (electrical shock and complete heart block). In these animals, in vivo measures of EVLW correlated closely with standard gravimetric techniques (r = 0.87, p less than .001), although the indicator dilution technique tended to underestimate actual lung water at higher volumes. In an additional 26 dogs, fluid (lactated Ringer's solution) was administered directly into a distal pulmonary airway, producing alveolar rather than interstitial edema. In these animals, as the infused volume was increased, the thermal technique underestimated consistently the actual amount of infused fluid. Nonetheless, we conclude that in most clinical and experimental situations where moderate changes in lung water are anticipated, this technique can provide reasonable estimates of extravascular fluid accumulation.