床旁超声%肺疾病,阻塞性,慢性%心源性肺水肿%重症医学科
床徬超聲%肺疾病,阻塞性,慢性%心源性肺水腫%重癥醫學科
상방초성%폐질병,조새성,만성%심원성폐수종%중증의학과
Bedside ultrasound%Chronic obstructive pulmonary disease%Cardiac pulmonary edema%Department of Critical Care Medicine
目的 探讨床旁实时超声诊断技术对慢性阻塞性肺疾病(COPD)和心源性肺水肿的临床诊断价值.方法 采用前瞻性单盲临床研究方法,纳入2012年9月至2013年9月安徽医科大学附属省立医院重症医学科收治的89例呼吸衰竭患者,其中临床诊断为COPD 32例,心源性肺水肿31例,间质性肺病8例,肺部感染12例,其他6例.另选择30例非肺部疾病患者作为对照组.所有患者于入院后24 h内进行床旁超声扫描,观察是否存在胸膜线平行线(“A”线)和彗星尾征(“B”线),同时完成胸部X线检查.超声检查“A”线阳性被定义为COPD,“B”线阳性被定义为心源性肺水肿.结果 89例患者中,超声检查“A”线阳性33例、平均(2.94±1.87)条/例,超声检查“B”线阳性38例、平均(3.27±1.72)条/例;对照组“A”线(1.94±0.96)条/例,“B”线(1.74±0.82)条/例;两组比较差异有统计学意义(“A”线:t=3.835,P=0.000;“B”线:t=6.540,P=0.000).32例临床诊断COPD患者中有26例“A”线阳性,符合率为81.2％;31例临床诊断为心源性肺水肿患者中有25例“B”线阳性,符合率为80.6％.超声“A”线阳性诊断COPD的敏感度为81.30％,特异度为87.70％,阳性预测值为78.80％,阴性预测值为89.30％;超声“B”线阳性诊断心源性肺水肿的敏感度为80.60％,特异度为77.60％,阳性预测值为65.80％,阴性预测值为88.20％.而X线胸片诊断COPD的敏感度为65.50％,特异度为86.00％,阳性预测值为72.40％,阴性预测值为81.70％;X线胸片诊断心源性肺水肿的敏感度为74.20％,特异度为69.00％,阳性预测值为56.10％,阴性预测值为83.30％.在诊断COPD方面,超声“A”线和X线影像学技术均可用于诊断,且诊断价值相当[受试者工作特征曲线下面积(AUC):0.833比0.816,P＞0.05],但“A”线Kappa值大于X线影像学诊断技术(0.685比0.527).在诊断心源性肺水肿方面,超声“A”线的诊断价值不大,AUC为0.305;而“B”线可用于诊断,诊断价值优于X线影像学技术(AUC:0.888比0.747,P＜0.001),且Kappa值大于X线影像学诊断技术(0.553比0.481).结论 床旁超声技术可用于COPD和心源性肺水肿等相关呼吸系统疾病的临床辅助诊断,且具有实时动态、便于反复检查的特点.
目的 探討床徬實時超聲診斷技術對慢性阻塞性肺疾病(COPD)和心源性肺水腫的臨床診斷價值.方法 採用前瞻性單盲臨床研究方法,納入2012年9月至2013年9月安徽醫科大學附屬省立醫院重癥醫學科收治的89例呼吸衰竭患者,其中臨床診斷為COPD 32例,心源性肺水腫31例,間質性肺病8例,肺部感染12例,其他6例.另選擇30例非肺部疾病患者作為對照組.所有患者于入院後24 h內進行床徬超聲掃描,觀察是否存在胸膜線平行線(“A”線)和彗星尾徵(“B”線),同時完成胸部X線檢查.超聲檢查“A”線暘性被定義為COPD,“B”線暘性被定義為心源性肺水腫.結果 89例患者中,超聲檢查“A”線暘性33例、平均(2.94±1.87)條/例,超聲檢查“B”線暘性38例、平均(3.27±1.72)條/例;對照組“A”線(1.94±0.96)條/例,“B”線(1.74±0.82)條/例;兩組比較差異有統計學意義(“A”線:t=3.835,P=0.000;“B”線:t=6.540,P=0.000).32例臨床診斷COPD患者中有26例“A”線暘性,符閤率為81.2％;31例臨床診斷為心源性肺水腫患者中有25例“B”線暘性,符閤率為80.6％.超聲“A”線暘性診斷COPD的敏感度為81.30％,特異度為87.70％,暘性預測值為78.80％,陰性預測值為89.30％;超聲“B”線暘性診斷心源性肺水腫的敏感度為80.60％,特異度為77.60％,暘性預測值為65.80％,陰性預測值為88.20％.而X線胸片診斷COPD的敏感度為65.50％,特異度為86.00％,暘性預測值為72.40％,陰性預測值為81.70％;X線胸片診斷心源性肺水腫的敏感度為74.20％,特異度為69.00％,暘性預測值為56.10％,陰性預測值為83.30％.在診斷COPD方麵,超聲“A”線和X線影像學技術均可用于診斷,且診斷價值相噹[受試者工作特徵麯線下麵積(AUC):0.833比0.816,P＞0.05],但“A”線Kappa值大于X線影像學診斷技術(0.685比0.527).在診斷心源性肺水腫方麵,超聲“A”線的診斷價值不大,AUC為0.305;而“B”線可用于診斷,診斷價值優于X線影像學技術(AUC:0.888比0.747,P＜0.001),且Kappa值大于X線影像學診斷技術(0.553比0.481).結論 床徬超聲技術可用于COPD和心源性肺水腫等相關呼吸繫統疾病的臨床輔助診斷,且具有實時動態、便于反複檢查的特點.
목적 탐토상방실시초성진단기술대만성조새성폐질병(COPD)화심원성폐수종적림상진단개치.방법 채용전첨성단맹림상연구방법,납입2012년9월지2013년9월안휘의과대학부속성립의원중증의학과수치적89례호흡쇠갈환자,기중림상진단위COPD 32례,심원성폐수종31례,간질성폐병8례,폐부감염12례,기타6례.령선택30례비폐부질병환자작위대조조.소유환자우입원후24 h내진행상방초성소묘,관찰시부존재흉막선평행선(“A”선)화혜성미정(“B”선),동시완성흉부X선검사.초성검사“A”선양성피정의위COPD,“B”선양성피정의위심원성폐수종.결과 89례환자중,초성검사“A”선양성33례、평균(2.94±1.87)조/례,초성검사“B”선양성38례、평균(3.27±1.72)조/례;대조조“A”선(1.94±0.96)조/례,“B”선(1.74±0.82)조/례;량조비교차이유통계학의의(“A”선:t=3.835,P=0.000;“B”선:t=6.540,P=0.000).32례림상진단COPD환자중유26례“A”선양성,부합솔위81.2％;31례림상진단위심원성폐수종환자중유25례“B”선양성,부합솔위80.6％.초성“A”선양성진단COPD적민감도위81.30％,특이도위87.70％,양성예측치위78.80％,음성예측치위89.30％;초성“B”선양성진단심원성폐수종적민감도위80.60％,특이도위77.60％,양성예측치위65.80％,음성예측치위88.20％.이X선흉편진단COPD적민감도위65.50％,특이도위86.00％,양성예측치위72.40％,음성예측치위81.70％;X선흉편진단심원성폐수종적민감도위74.20％,특이도위69.00％,양성예측치위56.10％,음성예측치위83.30％.재진단COPD방면,초성“A”선화X선영상학기술균가용우진단,차진단개치상당[수시자공작특정곡선하면적(AUC):0.833비0.816,P＞0.05],단“A”선Kappa치대우X선영상학진단기술(0.685비0.527).재진단심원성폐수종방면,초성“A”선적진단개치불대,AUC위0.305;이“B”선가용우진단,진단개치우우X선영상학기술(AUC:0.888비0.747,P＜0.001),차Kappa치대우X선영상학진단기술(0.553비0.481).결론 상방초성기술가용우COPD화심원성폐수종등상관호흡계통질병적림상보조진단,차구유실시동태、편우반복검사적특점.
Objective To study the diagnostic accuracy of bedside lung ultrasound examination in chronic obstructive pulmonary disease (COPD) and cardiac pulmonary edema.Methods A prospective pilot and single-blind trial was conducted.A total of 89 patients with respiratory failure admitted to the Department of Critical Care Medicine of Anhui Provincial Hospital from September 2012 to September 2013 were enrolled.There were 32 patients with COPD,31 patients with cardiac pulmonary edema,8 patients with interstitial lung disease,12 with lung infection,and 6 patients with other diseases.Another group of 30 patients without respiratory disease were enrolled as the control group.Bedside lung ultrasound examinations were performed in all patients within 24 hours,and chest radiograph was performed at the same time.The signs to be revealed were the "A" lines or horizontal lines arising from the pleural line,and the comet-tail artifact ("B" lines) arising from the lung wall interface.Results Of 89 patients,33 patients were shown a mean of 2.94 ± 1.87 "A" lines per case with the bedside lung ultrasound,and 38 patients with a mean of 3.27 ± 1.72 "B" lines per patient.1.94 ± 0.96 "A" lines a case and 1.74 ± 0.82 "B" lines a case in control group.There were significant difference between the test group and control group ("A"line:t=3.835,P=0.000; "B" line:t=6.540,P=0.000).Among 32 cases with COPD,28 patients had a positive result of "A" line with a coincidence rate of 81.2％.In the 31 patients with cardiac pulmonary edema,25 patients presented "B" line,with a coincidence rate of 80.6％.The "A" lines or horizontal lines arising from the pleural line showed a sensitivity of 81.30％ and a specificity of 87.70％ with a positive predictive value (PPV) 78.80％ and a negative predictive value (NPV) 89.30％ of in the diagnosis of COPD,and the "B" lines showed a sensitivity of 80.60％ and a specificity of 77.60％ with a PPV of 65.80％ and a NPV of 88.20％ in the diagnosis of cardiac pulmonary edema.However,X-ray examination showed a sensitivity of 65.50％,a specificity of 86.00％,a PPV of 72.40％ and a NPV of 81.70％ in the diagnosis of COPD,and it showed a sensitivity of 74.20％,a specificity of 69.00％,a PPV of 56.10％ and a NPV of 83.30％ in the diagnosis of cardiac pulmonary edema.Bedside ultrasound was highly consistent with X-ray in diagnosis of COPD [area under receiver operating characteristic curve (AUC):0.833 vs.0.816,P＞0.05],but Kappa value of ultrasound technology "A" line in the diagnosis of COPD was greater than the value of X-ray imaging techniques (0.685 vs.0.527).There was little diagnostic value of ultrasound "A" line in cardiac pulmonary edema (AUC was 0.305),while the "B" line was superior to X-ray (AUC:0.888 vs.0.747,P＜0.001),and had a higher Kappa value than the value of X-ray imaging techniques (0.553 vs.0.481) in cardiac pulmonary edema.Conclusions We conclude that bedside ultrasound is cost-effective,easy for repeated examination,and suitable for differential diagnosis of lung diseases.It might be useful in screening for COPD and cardiac pulmonary edema.
