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。

Clinical Value of Bedside Pulmonary Ultrasound in the Treatment of Acute Respiratory Distress Syndrome in ICU

Objective: To investigate the clinical value of bedside pulmonary ultrasound (LUS) in acute respiratory distress syndrome (ARDS) in ICU. Methods: 60 suspected ARDS patients were examined by blood gas analysis, chest CT and LUS. 40 cases of ARDS were diagnosed by LUS. The sensitivity, specificity and accuracy of diagnosis of ARDS by LUS were analyzed. The ROC curve of diagnosis of ARDS by LUS score=18 was drawn and the area under the curve was calculated. According to Berlin criteria, ARDS patients were divided into two groups: group A (non-severe) and group B (severe). LUS score, EVLW and APACHE II score were compared between the two groups, and correlation analysis was made. According to the prognosis, the patients were divided into group C (death) and group D (survival). The LUS scores, EVLW scores and APACHE II scores of the two groups were recorded and compared. Results: The sensitivity, specificity and accuracy of LUS in the diagnosis of ARDS were 87.5%, 75.0% and 83.3%, respectively. The area under curve was 0.957, the standard error was 0.014, and the confidence interval was 0.029-0.985. The scores of LUS, EVLW and APACHE II in severe group were significantly higher than those in non-severe group (P<0.05). The results of LUS were positively correlated with the values of EVLW (r=0.763, P<0.05), and the results of LUS were positively correlated with APACHE II score (r=0.593, P<0.05). The LUS score, EVLW value and APACHE II score in the death group were significantly higher than those in the survival group (P<0.05). Conclusion: LUS can accurately diagnose ARDS, judge the condition and evaluate the prognosis. It has good clinical value.