Objective To evaluate the simplified pulmonary ultrasound assessment as a tool for assessing EVLW in critically ill patients entering the multicellular intensive care unit(ICU).Methods A total of 49 critically ill patients who needed mechanical ventilation were enrolled in the EICU hospital from January 2017 to June 2017.Lung ultrasound and thermal dilution(PiCCO system)were performed by two independent op-erators.The number of B lines was recorded by lung ultrasonography,and then the difference between the number of B lines between different diseases,and the parameters obtained from the B line and PiCCO system were compared.The correlation between the positive quadrant of the B line and the EVLWI was also evalua-ted.Learning software for analysis.Results A total of 49 patients completed lung ultrasonography and PiCOO assessment after admission.The average age was(65.9 ± 5.3)years old.Among them,16 cases had B line number <10.27 cases was always >10,and 14(28.6%)had the increase or decrease.The number of B lines in patients with AMI was significantly lower than in respiratory disease(P<0.001).There was no significant difference in the number of B lines between heart failure and COPD(P=0.496)and acute respiratory failure (P=0.710).The number of B lines of ARDS was significantly higher than that of other diseases(P<0.001). There was a positive correlation between the number of B lines and the extravascular lung water index(EV-LEI)(r= 0.928,P< 0.001),and the number of B lines was negatively correlated with PaO2/FiO2(r=―0.876,P<0.001).When EVLWI was calculated using the actual weight,EVCOW was used to monitor the specificity(60%)and sensitivity(100%)of B line positive in more than 3 quadrants when EVLWI>10 mL/kg(area under the ROC curve:0.918;95% CI:0.846―0.991,P=0.037),using predicted body weight,more than 4 quadruples have B positive specificity(100%)and sensitivity(65%)(area under the curve:0.862;95%CI:0.759―0.965,P=0.004 8).Conclusion Simplified pulmonary ultrasound can be used as a reliable non-invasive bedside monitoring tool for predicting extravascular lung water in emergency and critically ill pa-tients.%目的 探讨简化肺超声作为评估进入多价重症监护病房(ICU)的危重患者血管外肺水(EVLW)的检测手段.方法 选取2017年1-6月该院EICU收治的49例需要机械通气的危重患者.肺超声检查和热稀释法(PiCCO)系统由2名独立操作者进行.运用肺部超声记录B线数目,然后比较不同疾病之间的B线数目,以及B线阳性和PiCCO系统获得的参数进行比较,同时评估B线阳性象限与血管外肺水指数(EVLWI)的相关性.结果 49例患者完成肺部超声检查及PiCOO评估,平均年龄(65.9 ± 5.3)岁,其中有16例B线数目始终小于10条,27例患者B线数目始终大于10条,14例(28.6%)动态观察B线数目有增减.急性心肌梗死患者的B线数目明显低于呼吸系统疾病(P<0.001).心力衰竭与慢性阻塞性肺疾病(COPD)(P=0.496)、急性呼吸衰竭(P=0.710)之间的B线数目比较,差异无统计学意义(P>0.05).急性呼吸窘迫综合征(A RDS)的B线数目明显多于其他疾病(P<0.001).B线数目与EVLEI(实际体质量)呈正相关(r=0.928,P<0.001),B线数目与 PaO2/FiO2呈负相关(r= -0.876,P< 0.001).采用实际体质量计算 EVLWI,PiCOO 监测EVLWI>10 mL/kg时,超过3个象限存在B线阳性的特异性(60%)和敏感性(100%)(曲线下面积:0.918;95% CI:0.846~0.991,P=0.037).使用预测体质量计算时,超过4个象限存在B线阳性的特异性(100%)和敏感性(65%)(曲线下面积:0.862;95% CI:0.759~0.965,P=0.0048).结论 简化的肺超声方法可作为可靠的非侵入性床边监测工具,用于预测紧急和重症患者的EVLW.
展开▼
