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1. 济宁医学院附属医院超声医学科
2. 济宁医学院附属医院胃肠外二科
纸质出版日期:2020,
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[1]张萌,李聪,王克诚.心肺联合超声判断急性呼吸窘迫综合征患者预后的价值[J].临床超声医学杂志,2020,22(12):911-915.
ZHANG Meng, LI Cong, WANG Kecheng. Value of combined cardiopulmonary ultrasound in the prognosis of patients with acute respiratory distress syndrome[J]. Journal of Clinical Ultrasound in Medicine, 2020,22(12):911-915.
[1]张萌,李聪,王克诚.心肺联合超声判断急性呼吸窘迫综合征患者预后的价值[J].临床超声医学杂志,2020,22(12):911-915. DOI: 10.16245/j.cnki.issn1008-6978.2020.12.012.
ZHANG Meng, LI Cong, WANG Kecheng. Value of combined cardiopulmonary ultrasound in the prognosis of patients with acute respiratory distress syndrome[J]. Journal of Clinical Ultrasound in Medicine, 2020,22(12):911-915. DOI: 10.16245/j.cnki.issn1008-6978.2020.12.012.
目的探讨心肺联合超声对急性呼吸窘迫综合征(ARDS)患者预后的预测价值。方法选取我院收治的ARDS患者124例
根据治疗28 d内生存情况
将其分为存活组66例和死亡组58例
比较两组临床资料、治疗情况及心肺联合超声检查情况。采用多因素Logistic回归分析影响患者预后的相关因素
绘制受试者工作特征(ROC)曲线评价心肺联合超声指标评估患者预后的诊断效能。结果两组患者年龄、ARDS类型、ARDS分级、合并休克、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分及序贯器官衰竭估计(SOFA)评分间比较差异均有统计学意义(均P<0.05)。存活组患者肺部超声评分、二尖瓣舒张早期血流峰值速度与二尖瓣舒张早期运动峰值速度的比值(E/E’)均低于死亡组
而三尖瓣环收缩期位移(TAPSE)、二尖瓣流速E、A峰比值(E/A)均高于死亡组(均P<0.05)。Logistic回归分析显示
年龄、ARDS类型(肺内型)、合并休克、APACHEⅡ评分15~25分、SOFA评分>6分、肺部超声评分、TAPSE、E/A及E/E’均是患者预后的独立影响因素。ROC曲线分析显示
肺部超声评分、TAPSE、E/A、E/E’及其联合应用的曲线下面积分别为0.857、0.869、0.741、0.771及0.933
截断值分别为14.50分、21.750 mm、0.912、11.650及-1.585
敏感性分别为89.7%、89.4%、66.8%、89.2%及86.2%
特异性分别为66.7%、79.3%、85.2%、82.4%及90.9%。结论心肺联合超声对ARDS患者预后具有较高的预测价值
临床可推广应用。
Objective To explore the predictive value of cardiopulmonary combined ultrasound in the prognosis ofpatients with acute respiratory distress syndrome(ARDS).MethodsA total of 124 patients with ARDS admitted to our hospitalwere selected.According to the survival within 28 d of treatment
the patients were divided into survival group(n=66)and deathgroup(n=58).The clinical data
treatment status
and cardiopulmonary combined ultrasound examinations of the two groups werecompared.Multivariate Logistic regression analysis was used to analyze the relevant factors affecting the prognosis of the patients.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic efficacy of cardiopulmonary combinedultrasound indexes on patient prognosis.ResultsThere were significant differences between the two groups in age
ARDS type
ARDS grade
combined shock
acute physiology and chronic health scoring system Ⅱ(APACHE Ⅱ)score and sequential organfailure estimate(SOFA)score
the differences were statistically significant(all P<0.05). The lung ultrasound score
the peakearly diastolic blood flow velocity and the peak early diastolic motion of the mitral valve(E/E’)of the surviving group were lowerthan those in the death group
while the tricuspid annulus systolic displacement(TAPSE)
the peak ratio of mitral valve flowvelocity and mitral valve velocity(E/A)were higher than those in the death group(all P<0.05). Logistic regression analysisshowed that age
ARDS type(intrapulmonary type)
combined shock
APACHE Ⅱ score(15~25 points)
SOFA score(>6 points)lung ultrasound score
TAPSE
E/A and E/E’were all independent factors affecting the prognosis in patients with ARDS.ROCcurve showed that the area under the curve of lung ultrasound score
TAPSE
E/A
E/E’and their combination were 0.857
0.869
0.741
0.771 and 0.933
respectively
and the cutoff values were 14.50 points
21.750 mm
0.912
11.650 and-1.585
thesensitivities were 89.7%
89.4%
66.8%
89.2% and 86.2%
the specificities were 66.7%
79.3%
85.2%
82.4% and 90.9%
respectively.ConclusionCardiopulmonary combined ultrasound has a high predictive value for the prognosis of ARDSpatients
and it can be used in clinical applications.
心肺超声呼吸窘迫综合征急性预测价值
Cardiopulmonary ultrasoundRespiratory distress syndromeacutePredictive value
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