床旁肺部超声在重症脑卒中神经源性肺水肿筛查中的应用

摘要

Objective To investigate the application of bedside lung ultrasound in screening of severe stroke complicated with neurogenic pulmonary edema (NPE).Methods A total of 35 patients with severe stroke admitted from Augest to December 2016 underwent lung ultrasound examination within 3 d after the onset daily, and the patients with pulmonary edema by ultrasound examination were given further blood gas analysis and bedside chest X-ray examinations, and then the diagnosis of NPE was confirmed.The sensitivity, specificity and coincidence rate of lung ultrasound diagnostic method were calculated by the four grid method.Results Bedside lung ultrasound examination showed 11 patients with pulmonary edema, in whom the pulmonary edema was found within 24 h after the onset in 7 patients, and other 4 patients were found within 48-72 h after the onset.Chest X-ray showed pulmonary edema in 5 patients, while 6 patients with pulmonary edema with slight symptom by bedside lung ultrasound examination showed no pulmonary edema by chest X-ray examination.Diagnostic efficacy analysis showed that the sensitivity of lung ultrasound in diagnosis of NPE was 100.0%;specificity was 80.0%, and the coincidence rate was 82.8%.Conclusion Lung ultrasound examination can diagnose pulmonary edema, and it is suitable for bedside diagnosis of severe patients.%目的 探讨床旁肺部超声在重症脑卒中神经源性肺水肿(neurogenic pulmonary edema, NPE)筛查中的应用.方法 选取我院急诊科2016年8-12月急诊科抢救室收治的重症脑卒中35例,发病后3 d内每日行床旁肺部B超检查,对超声提示肺水肿者进一步行血气分析、床旁X线胸片检查证实NPE诊断.采用诊断试验四格表法计算肺部超声诊断方法的敏感度、特异度及符合率.结果 床旁超声检查提示肺水肿11例,7例在发病24 h内出现,4例在发病48~72 h出现.5例X线胸片提示肺水肿;6例床旁超声提示肺水肿且症状轻微者X线胸片未提示肺水肿.诊断效能分析结果显示,床旁肺部超声诊断NPE的敏感度为100.0%,特异度为80.0%,符合率为82.8%.结论 根据肺部超声结果可诊断肺水肿,适用于危重症患者的床旁诊断,有一定的临床推广价值.