床旁超声检查评估急性呼吸衰竭病因的临床应用

发布时间：2018-04-18 09:53

本文选题：急性呼吸衰竭 + 床旁超声　；参考：《上海医学》2016年01期

【摘要】：目的比较床旁心、肺联合超声检查与常规检查诊断急性呼吸衰竭病因的准确率和诊断价值。方法收集复旦大学附属中山医院2014年1月-2015年6月因急性呼吸衰竭收入ICU的成年患者。分别经常规检查(询问病史、体格检查和胸部X线摄片检查)和床旁心、肺联合超声检查得出病因诊断,比较两者诊断急性呼吸衰竭病因的准确率,并通过描绘ROC曲线评价两者在急性呼吸衰竭病因方面的诊断价值。结果 109例患者入组,其中肺相关因素占45.9%(50/109),心脏相关因素占17.4%(19/109),感染相关因素占18.3%(20/109),其他因素(反流误吸、呼吸肌神经肌肉病变)占18.3%(20/109)。床旁超声检查诊断与最终诊断的符合率为84.4%(92/109),显著高于常规检查的65.1%(71/109,P=0.001)。床旁超声检查和常规检查在诊断急性呼吸衰竭为肺相关因素所致的AUC分别为0.928(P=0.027)和0.743(P=0.048),诊断为心脏相关因素所致的AUC分别为0.957(P=0.032)和0.814(P=0.066),诊断为感染相关因素所致的AUC分别为0.944(P=0.040)和0.789(P=0.070),诊断为其他因素所致的AUC分别为0.889(P=0.054)和0.750(P=0.074)。结论床旁超声检查诊断肺、心脏和感染相关因素所致的急性呼吸衰竭的特异度和敏感度均高于常规检查,床旁心、肺联合超声检查可提高急性呼吸衰竭病因诊断的准确率,诊断价值较高。
[Abstract]:Objective to compare the accuracy and diagnostic value of combined echocardiography and routine examination in the diagnosis of acute respiratory failure (ARF).Methods Adult patients with acute respiratory failure (ICU) in Zhongshan Hospital affiliated to Fudan University from January 2014 to June 2015 were collected.Routine examination (asking history, physical examination and chest X-ray examination) and bedside heart and lung combined ultrasonography were used to obtain the etiological diagnosis, and the accuracy of diagnosis of acute respiratory failure was compared.The diagnostic value of ROC curve in the etiology of acute respiratory failure was evaluated.Results 109 patients were enrolled in the study. Pulmonary factors accounted for 50 / 109, heart related factors accounted for 17.4 / 109, infection related factors accounted for 18.3 / 109, and other factors (reflux aspiration, respiratory neuromuscular lesion) accounted for 18.3 / 10 9 / 20 / 10 9 / 10 9 respectively.The coincidence rate between the diagnosis of bedside ultrasound and the final diagnosis was 84.4 / 109g, which was significantly higher than that of 65.1 / 109P0. 001by routine examination.In the diagnosis of acute respiratory failure, the AUC of bedside ultrasound and routine examination were 0.928 P0. 027) and 0. 743%, the AUC of diagnosis of heart-related factors were 0. 957 and 0. 032), and the AUC of diagnosis of infection related factors were 0. 814 and 0. 066, respectively.The AUC for diagnosis of other factors were 0.889, 0.054) and 0.750, respectively, and the results showed that the AUC was 0. 084 and 0. 074%, respectively, and 0. 944%, 0. 044) and 0. 789% (P = 0. 040) and 0. 789 (0. 074) respectively.Conclusion the specificity and sensitivity of bedside ultrasonography in the diagnosis of acute respiratory failure caused by heart and infection related factors are higher than that of routine examination. The accuracy of diagnosis of acute respiratory failure can be improved by the combination of bedside echocardiography and pulmonary ultrasonography.The diagnostic value is high.
【作者单位】：复旦大学附属中山医院重症监护室;
【基金】：中山医院人才培养-优秀骨干计划资助(2015ZSYXGG-01)
【分类号】：R563.8

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