急性左心衰患者肺部超声影像变化及其临床意义

目的通过观察肺部超声影像(LUS)在急性左心衰患者中的变化,评价LUS在急性左心衰诊断及鉴别诊断中的意义。方法随机选取88例急性呼吸困难患者,根据其病因分为急性左心衰组(A组)和非急性左心衰组(B组)。对两组患者行肺部超声检查计算肺部超声彗星尾征(ULCs)数目,超声心动图测量EF值、E/Ea值,并测定静脉血N末端B型钠尿肽原(NT-proBNP)。比较两组患者ULCs数目、EF值、E/Ea值和NT-proBNP的差别,以及ULCs数目与EF值、E/Ea值以及NT-proBNP之间的相关性。结果 A组ULCs中位数(21 vs.3)、NT-proBNP中位数(3785 pg/ml vs.412 pg/ml)以及E/Ea(12.05±3.38 vs.6.65±2.23)明显高于B组(P<0.05);A组EF(0.35±0.07 vs.0.58±0.04)明显低于B组(P<0.05)。ULCs数目与NT-proBNP水平(r=0.396,P<0.05)和E/Ea值(r=0.460,P<0.05)呈正相关,与EF值负相关(r=-0.713,P<0.05)。结论急性左心衰患者LUS可见明显ULCs,急性左心衰程度越重,ULCs数目越多。LUS有助于早期判断急性左心衰严重程度,并有助于与其他疾病所致急性呼吸困难相鉴别。

Discussing about the changes of the lung ultrosonography and its clinical value in acute left heart failure patients

Objective To observe the changes in lung ultrosonography（LUS） of acute left heart failure patients, to investigate the diagnosic and differential diagnosic values of LUS for acute left heart failure patients. Methods Random select a total of 88 patients with acute dyspnea, who were divided into acute left heart failure（ALHF） group（group A） and non-ALHF group（group B）. Both groups were studied by LUS to count ultrasound lung comets（ULCs）, left ventricular ejection fraction（EF） and the ratio of early diastolic mitral inflow velocity to early diastolic velocity of the mitral annulus （E/Ea） by transthoracic echocardiography examination, and measurement NT-proBNP levels. Comparing with the number of ULCs, the value of EF, the value of E/Ea and the levels of NT-proBNP between group A and group B, then analyse the correlation between the ULCs and EF, E/Ea, NT-proBNP levels. Results Between the group A and group B there were significant difference in ULCs, NT-proBNP, EF and E/Ea. The median of ULCs in group A（21） were significantly higher than group B（3）, the median of NT-proBNP levels in group A（3785 pg/ml） were also significant higher than group B（412 pg/ml）, the numerical value of EF in group A（0.35±0.07） were lower than group B（0.58±0.04）, and the numerical value of E/Ea in group A（12.05±3.38） was higher than group B（6.65±2.23）.The number of ULCs were correlated with the NT-proBNP levels（ r=0.396, P＆lt;0.05）, the value of E/Ea（r=0.460, P＆lt;0.05） and the value of EF（r=-0.713, P＆lt;0.05）. Conclusion ULCs could be seen in the LUS of the acute left heart failure patients, and its number is positively correlated with the severity of the acute left heart failure. LUS helps early diagnosis of＆amp;nbsp;acute left heart failure severity, and help to differentiate from other diseases caused by acute dyspnea.