肺部超声在孕妇社区获得性肺炎诊断中的价值

发布时间：2018-07-24 07:47

【摘要】：背景和目的：孕妇社区获得性肺炎(Community acquired pneumonia CAP)是一种妊娠期间严重的疾病,妊娠期肺炎的病程、严重程度和病死率均较非妊娠期增加并增加早产和低出生体重儿的风险。因此早期及时准确的诊断对妊娠期肺炎具有重要的意义。本研究对2014年1月1日至9月30日,杭州市第一人民医院急诊科收治的疑似肺炎的45例孕妇患者进行肺部超声(Lung ultrasound LUS)和X线胸片检查,分析LUS和X线胸片之间的一致性。通过与X线胸片比较,探索肺部超声在孕妇肺炎诊断中的可靠性,希望能够为妊娠期肺炎的诊断寻找一种无辐射、简便易行、可靠且重复性好的手段。方法：本研究为前瞻性诊断性研究,经过医院伦理委员会批准,并获得患者及家属知情同意。将2014年1月1日至2014年9月30日期间,纳入我院急诊科有发热咳嗽咳痰而疑似肺炎的45例孕周4周孕妇患者,在知情同意的前提下,入院后24h内行X线胸片、LUS及血常规检查,X线胸片由具有资质的放射科医师出具报告,LUS由经过床边B超训练的急诊医师或具有资质的B超医师进行检查。B超检查者并不知晓X线胸片报告,B超结果不影响临床医师的治疗决策。安静状态下,孕妇患者取仰卧、侧卧或坐位,以腋前线、腋中线、腋后线为界,将肺脏分为前、侧、后三个区域,探头与肋骨垂直分别对双侧肺脏的每个区域进行扫查,观察是否存在肺实变(Lung consolidation LC)、A-线(A-line)消失、多量B-线(B-line)出现及肺搏动(Lung pulse LP),出现上述4个特征性影像学改变中的1个或以上即为阳性。根据临床症状、放射影像学、实验室检查由2名副高以上的临床医师做出肺炎的诊断。确诊肺炎的孕妇患者作为肺炎组,非肺炎的孕妇患者作为对照组,分析LUS在孕妇肺炎中的影像学特点,对LUS与X线胸片进行相关性分析,使用SPSS19.0软件对数据进行统计分析,计量资料以x±s标准差表示,组间比较采用t检验。计算LUS对孕妇CAP诊断的特异性、敏感性、假阳性率、假阴性率、阳性预测值、阴性预测值和准确度。对LUS与X线胸片诊断CAP的一致性进行Kappa检验。P0.05为差异有统计学意义。结果： (1)共入组45例患者,平均年龄28.0±2.54岁。孕4周～12周占20%(9/45),13周～27周占46.7%(21/45),28周～40周占33.3%(15/45)。肺炎组27例(60%),对照组占18例(40%)。肺炎组白细胞数目较对照组明显升高(P0.05),而年龄、孕周无明显差异(P0.05)。 (2)对照组患者中,LUS中的肺实变、肺搏动出现例数均为0,多量B-线出现1例(5.6%),A线消失2例(11.1%)；肺炎组患者中,肺实变21例次(77.8%),多量B-线25例次(92.6%),A-线消失25例次(92.6%),肺搏动5例次(18.5%),两组间差异有统计学意义,P值均0.001。 (3)LUS对CAP诊断的敏感度为92.6%,特异度为89.5%,假阳性率10.5%,假阴性率3.8%,阳性预测值82.6%,阴性预测值94.4%,准确度93.3%,KAPPA值0.862,说明与X线胸片的一致性好。结论：肺部超声与X线胸片诊断孕妇社区获得性肺炎的一致性较好,超声检查具有无辐射、方便易行、可重复的特点,适用于于对疑似肺炎的孕妇的诊断,值得进一步研究。
[Abstract]:Background and purpose:
Community acquired pneumonia CAP is a serious disease during pregnancy. The course of pregnancy, severity and mortality of gestation are higher than those in non pregnancy and increase the risk of premature and low birth weight. Therefore, early and accurate diagnosis is of great significance for pregnancy pneumonia. From January 1, 2014 to September 30th, 45 pregnant women with suspected pneumonia in the emergency department of No.1 People's Hospital of Hangzhou were examined by lung ultrasound (Lung ultrasound LUS) and X-ray chest X-ray. The consistency between LUS and X-ray chest films was analyzed. The reliability of lung ultrasound in the diagnosis of pneumonia in pregnant women was explored by comparing with X-ray chest films. It is a simple, reliable and reproducible method for the diagnosis of pregnancy pneumonia.
Method:
This study was a prospective diagnostic study, approved by the hospital ethics committee, and obtained the informed consent of the patients and their families. From January 1, 2014 to September 30, 2014, 45 pregnant women with fever, cough and expectoration and suspected pneumonia were included in the emergency department of our hospital from January 1, 2014 to September 30, 2014. On the premise of knowledge consent, 24h X-ray chest films were performed in the hospital after admission, LU S and blood routine examination, X-ray chest radiographs issued by a qualified radiologist, LUS by an emergency physician or a qualified B ultrasonic doctor trained by bedside B-ultrasound. B ultrasonic examiners do not know the chest x-ray report. B ultrasonic results do not affect the treatment decision of the clinician. In quiet state, pregnant women are supine, lateral or sitting. Position, with the frontline of axillary, midline of axillary and axillary posterior line as boundary, the lung was divided into the front, the side, and the back three regions, the probe and the ribs were scanned in each area of the bilateral lungs respectively, and the presence of Lung consolidation LC, the A- line (A-line) disappeared, the multiple B- line (B-line) and the lung pulsation (Lung pulse LP), and the above 4 characteristics appeared. 1 or more of the changes in sexual imaging were positive. According to clinical symptoms, Radiology, and laboratory examination, the diagnosis of pneumonia was made by 2 clinicians above the subtropical high. The pregnant women who confirmed pneumonia were treated as pneumonia group and non pneumonia pregnant woman as control group. The imaging characteristics of LUS in pregnant women were analyzed, and LUS and X ray were used. Correlation analysis of chest films, statistical analysis of data using SPSS19.0 software, x + s standard deviation of measurement data and t test among groups. The specificity, sensitivity, false positive rate, false negative rate, false negative rate, positive predictive value, negative pretest value and accuracy of LUS for pregnant women's CAP were calculated. The consistency of LUS with X-ray chest X-ray diagnosis of CAP Kappa test was performed. The difference was statistically significant in P 0.05.
Result:
(1) the average age of 45 patients, the average age of 28 + 2.54 years, 4 weeks to 12 weeks of pregnancy 20% (9/45), 13 to 27 weeks, 46.7% (21/45), 28 to 40 weeks occupy 33.3% (15/45), pneumonia group, the number of leukocytes in the pneumonia group was significantly higher than the control group (P0.05), but the age, no significant difference between the gestational weeks (P0.05).
(2) in the control group, the pulmonary consolidation in LUS and the number of pulmonary pulsation were 0, the multiple B- line appeared in 1 cases (5.6%), and the A line disappeared in 2 cases (11.1%); in the pneumonia group, the pulmonary consolidation was 21 times (77.8%), the multiple B- line was 25 (92.6%), the A- line disappeared (92.6%), and the pulmonary pulsation was statistically significant, and the P value was 0.001.
(3) the sensitivity of LUS to the diagnosis of CAP was 92.6%, the specificity was 89.5%, the false positive rate was 10.5%, the false negative rate was 3.8%, the positive predictive value was 82.6%, the negative predictive value was 94.4%, the accuracy was 93.3%, and the KAPPA value was 0.862, indicating good consistency with the X-ray chest film.
Conclusion:
The consistency of pulmonary ultrasound and X-ray chest X-ray diagnosis of pregnant women's community acquired pneumonia is better. Ultrasound examination has no radiation, convenient and repeatable characteristics. It is suitable for the diagnosis of pregnant women with suspected pneumonia. It is worth further study.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.1;R714.253

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