肺超声在心源性肺水肿诊疗中的应用价值

目的探讨肺超声检查在发生心力衰竭患者心源性肺水肿的诊断及治疗监测中的应用价值。方法纳入2014年7月~2015年1月临床诊断为心力衰竭患者61例为研究对象。所有患者均接受超声心动图、肺超声及胸部CT检查,比较分析肺超声与胸部CT对心源性肺水肿的诊断价值;同时,对比分析患者治疗前后肺超声检查肺部B线数量与左心室射血分数的变化,并对B线数量和左心室射血分数进行Pearson相关分析。结果CT诊断心源性肺水肿52例,肺超声诊断心源性肺水肿50例,Kappa值为0.642,两者比较差异无统计学意义(P>0.05);治疗后患者肺部B线数量与左心室射血分数较治疗前显著改善(P<0.05);相关分析表明,治疗前后B线数量与射血分数两者之间在P=0.05水平均呈显著负相关(r_治疗前=-0.907,P<0.01;r_治疗后=-0.783,P<0.01)。结论肺超声可以作为诊断心力衰竭患者心源性肺水肿的可靠辅助检查方法之一,并可用于心源性肺水肿的治疗评价,具有重要临床应用价值。

Application Value of Lung Ultrasound in the Diagnosis and Treatment of Cardiogenic Pulmonary Edema.

Objective To investigate the application value of lung ultrasound examination in the diagnosis and therapeutic monitoring of heart failure patients with cardiogenic pulmonary edema. Methods Sixty one patients clinical diagnosised of heart failure from July 2014 to January 2015 were enrolled in the study. All the patients underwent echocardiography, lung ultrasound and chest CT exam, the diagnosis value of lung ultrasound and chest CT in the cardiogenic pulmonary edema was comparative analysised. At the same time, comparative analysising the changes of lung B-line numbers with lung ultrasound exam and left ventricular ejection fraction before and after the treatment in patients, correlation of B-line numbers and left ventricular ejection fraction were analyzed by Pearson correlation analysis. Results Fitty two patients were diagnosised by the chest CT and 50 patients were diagnosised by the lung ultrasound as cardiogenic pulmonary edema with Kappa value 0.642. There was no significant difference between two methods(P>0.05). The lung B-line numbers and left ventricular ejection fraction (P<0.05) were significantly improved after treatment compared with prior therapying. The correlation analysis showed that B-line numbers and left ventricular ejection fraction had a significant negative correlation at the level of P=0.05 before treatment (r=-0.907, P<0.01) and after therapy(r=-0.783,P<0.01). Conclusion Lung ultrasound can serve as one of the reliable auxiliary examination method in the diagnosis of cardiogenic pulmonary edema in heart failure patients, and can be used for the assessment of cardiogenic pulmonary edema therapying, which has important clinic application value.