肺部超声评分与重症肺炎患者病情进展的相关性

目的探讨肺部超声评分(LUS)与不同程度重症肺炎患者病情进展的相关性。方法选取189例重症肺炎患者为研究对象,根据急性生理与慢性健康(APACHEⅡ)评分分为非危重症组(53例)、危重症组(86例)及极危重症组(50例),随访3个月,比较各组LUS、临床肺部感染评分(CPIS)、序贯器官衰竭评分(SOFA)、氧合指数(OI)、肺泡-动脉氧分压差(A-aDO2)、机械通气时间的差异;根据LUS是否>16分将患者分为低LUS组108例和高LUS组81例,比较两组上述参数的差异。应用Pearson相关分析法分析LUS与CPIS、SOFA、OI、A-aDO2、机械通气时间的相关性。结果极危重症组LUS(21.38±6.84)分、CPIS(8.02±2.43)分、SOFA(6.72±2.24)分,均高于危重症组(19.15±6.23)分、(7.21±2.16)分、(5.93±2.11)分]和非危重症组(14.26±4.72)分、(6.58±2.07)分、(5.18±2.06分)],且危重症组高于非危重症组(均P<0.05)。极危重症组OI(103.27±41.36)mm Hg(1 mm Hg=0.133 kPa)低于危重症组(131.45±52.41)mm Hg和非危重组(157.53±60.52)mm Hg,且危重症组低于非危重症组(均P<0.05);极危重症组A-aDO2和机械通气时间分别为(350.16±137.23)mm Hg、(7.02±1.45)d,均高于危重症组(306.24±125.84)mm Hg、(6.23±1.36)d]和非危重症组(238.47±107.16)mm Hg、(5.34±1.27)d],且危重症组高于非危重症组(均P<0.05)。高LUS组CPIS(8.00±2.33)分、SOFA(6.79±1.41)分,均高于低LUS组(6.68±2.11)分、(5.74±1.32分),差异均有统计学意义(均P<0.05)。高LUS组OI(106.08±43.21)mm Hg低于低LUS组(150.23±58.17)mm Hg,A-aDO2和机械通气时间(363.78±141.39)mm Hg、(6.76±1.40)d]均高于低LUS组(250.16±110.28)mm Hg、(5.76±1.33)d],差异均有统计学意义(均P<0.05)。Pearson相关分析显示,LUS与CPIS、SOFA、A-aDO2、机械通气时间均呈正相关(r=0.587、0.591、0.651、0.321,P=0.002、0.003、0.000、0.041),与OI呈负相关(r=-0.753,P=0.000)。结论LUS与重症肺炎患者病情严重程度具有一定相关性,对临床评估肺炎疗效有一定指导价值。

Correlation between lung ultrasound score and disease progression in patients with severe pneumonia

Objective To explore the correlation of lung ultrasound score(LUS)and the progression of severe pneumonia patients with different severity.Methods A total of 189 patients with severe pneumonia were selected,they were divided into non-critically ill group(53 cases),critically ill group(86 cases),very critically ill group(50 cases)according to the acute physiology and chronic health(APACHEⅡ)score.All patients in each group was followed up for 3 months,and the LUS,clinical pulmonary infection score(CPIS),trans-organ failure score(SOFA),oxygenation index(OI),alveolar-arterial oxygen partial pressure difference(A-aDO2),and mechanical ventilation time among the groups were compared.The patients were divided into low LUS group(108 cases)and high LUS group(81 cases)according to whether LUS>16,and the differences of above parameters were compared between the two groups.The correlation between LUS and CPIS,SOFA,OI,A-aDO2,mechanical ventilation time was analyzed by Pearson correlation analysis.Results The LUS,CPIS and SOFA of very critically ill group were(21.38±6.84)points,(8.02±2.43)points,(6.72±2.24)points,which were higher than those of critically ill group(19.15±6.23)points,(7.21±2.16)points,(5.93±2.11)points]and non-critically ill group(14.26±4.72)points,(6.58±2.07)points,(5.18±2.06)points].And the parameters of critically ill group were higher than those of non-critically ill group(all P<0.05).The OI of very critically ill group was(103.27±41.36)mm Hg(1 mm Hg=0.133 kPa),which was lower than that of critically ill group(131.45±52.41)mm Hg and non-critical ill group(157.53±60.52)mm Hg,and the parameter of critically ill group was lower than that of non-critically ill group(all P<0.05).The A-aDO2 and mechanical ventilation time of very critically ill group were(350.16±137.23)mm Hg and(7.02±1.45)d,which were higher than those of critical group(306.24±125.84)mm Hg,(6.23±1.36)d]and non-critical group(238.47±107.16)mm Hg,(5.34±1.27)d],and the parameters of critically ill group were higher than those of the non-critically ill group(all P<0.05).The scores of CPIS and SOFA of high LUS group were(8.00±2.33)points and(6.79±1.41)points,which were higher than those of low LUS group(6.68±2.11)points,(5.74±1.32)points],the differences were statistically significant(both P<0.05).The OI of high LUS group was(106.08±43.21)mm Hg,which was lower than that of low LUS group(150.23±58.17)mm Hg.The A-aDO2 and mechanical ventilation time of high LUS group were(363.78±141.39)mm Hg and(6.76±1.40)d,which were higher than those of low LUS group(250.16±110.28)mm Hg,(5.76±1.33)d],the differences were statistically significant(all P<0.05).Pearson correlation analysis showed that LUS was positively correlated with CPIS,SOFA,A-aDO2 and mechanical ventilation time(r=0.587,0.591,0.651,0.321,P=0.002,0.003,0.000,0.041),but negatively correlated with OI(r=-0.753,P=0.000).Conclusion LUS score is correlated with the severity of patients with severe pneumonia,which has a certain guiding value for clinical evaluation of curative effect of pneumonia.