床旁肺超声评估老年慢性阻塞性肺病急性加重合并肺炎的应用价值陈娟,伍倩戎,张雪兰,李琴,陈玲

目的 探讨床旁肺部超声在老年慢性阻塞性肺病急性加重(AECOPD)合并肺炎患者病情评估中的临床应用价值。方法 选取AECOPD合并肺炎患者46例,均行床旁肺超声检查,计算每例患者的肺超声B线数量和肺部超声评分,分析肺部超声评分与氧合指数的相关性；应用ROC曲线分析肺部超声评分和氧合指数对AECOPD合并肺炎的诊断效能。结果46例患者肺部超声评分8.1±2.0。相关性分析显示,肺部超声评分与氧合指数呈负相关(r=-0.69,P<0.05)。ROC曲线分析显示,以肺部超声评分为8.7分为截断值,其诊断AECOPD合并肺炎的敏感性90.8%,特异性87.3%,准确率89.1%,曲线下面积0.814；以氧合指数193 mm Hg为截断值,其诊断AECOPD合并肺炎的敏感性87.2%,特异性83.3%,准确率85.6%,曲线下面积0.779。结论 床旁肺超声能准确评估慢性阻塞性肺病急性加重合并肺炎患者的肺部情况,操作简便易行,可重复性强,具有较好的临床应用价值。

The value of bedside lung ultrasound B-line counting in the assessment of acute exacerbation of chronic obstructive pulmonary disease with pneumonia

ObjectiveTo investigate the value of pulmonary ultrasound in the assessment of acute exacerbation of chronic obstructive pulmonary disease with pneumonia.Methods Forty-six patients with acute exacerbation of pneumonitis with chronic obstructive pulmonary disease were selected, who underwent bedside lung ultrasound examinations. The number of lung ultrasound B lines and lung ultrasound scores were calculated in each patient, and the correlation between the lung ultrasound scores and the oxygenation index was analyzed ; the ROC curve was used to analyze thediagnostic efficacy of the lung ultrasound scores and the oxygenation index for AECOPD with pneumonia.Results The lung ultrasound score of 46 patients was (8.1 ± 2.0) points. Correlation analysis showed that lung ultrasound score was negatively correlated with oxygenation index (r = -0.69, P <0.05). ROC curve analysis showed that the lung ultrasound score was 8.7, the cut-off value was 90.8%, the specificity was 87.3% ,the accuracy was 89.1% , and the area under the curve was 0.814 . The oxygenation index was 193 mm Hg. The cutoff value was 87.2% for the diagnosis of AECOPD with pneumonia, with a specificity of 83.3%, an accuracy of 85.6%, and an area under the curve of 0.779.ConclusionBedside ultrasound to determine the lungs of patients with acute exacerbation of chronic obstructive pulmonary disease and pneumonitis is relatively simple and reproducible,and have good clinical value.