中华内科杂志
中華內科雜誌
중화내과잡지
CHINESE JOURNAL OF INTERNAL MEDICINE
2015年
9期
778-782
,共5页
丁欣%王小亭%陈焕%赵华%晁彦公%尹万红%刘大为%中国重症超声研究组(CCUSG)
丁訢%王小亭%陳煥%趙華%晁彥公%尹萬紅%劉大為%中國重癥超聲研究組(CCUSG)
정흔%왕소정%진환%조화%조언공%윤만홍%류대위%중국중증초성연구조(CCUSG)
超声检查%肺%膈肌%重症
超聲檢查%肺%膈肌%重癥
초성검사%폐%격기%중증
Ultrasonography%Lung%Diaphragm%Critical care
目的 探讨改良床旁肺部超声(M-BLUE)方案与床旁肺部超声(BLUE)方案膈肌点位置与征象的差异.方法 选2015年1-2月连续入住北京协和医院重症医学科的患者61例,分别进行M-BLUE方案和BLUE方案检查,比较两种方案膈肌点检查位置及超声征象的差异.结果 (1)M-BLUE方案与BLUE方案所确定的膈肌点的位置有47.5％ (58/122)存在差异,有18.0％(22/122)超声征象存在差异.(2)与BLUE方案比,合并呼吸衰竭患者M-BLUE方案膈肌点位置的改变率[67.9％ (19/28)]和超声征象的改变率[42.9％ (12/28)]均高于未合并呼吸衰竭患者[33.3％(11/33);12.1％ (4/33)].确诊的5例急性呼吸窘迫综合征(ARDS)和6例慢性阻塞性肺疾病(COPD)患者膈肌点位置均发生改变,其中3例ARDS、4例COPD患者膈肌点征象亦发生改变.(3)合并呼吸衰竭患者M-BLUE方案所确定的膈肌点的超声征象与胸部CT更为一致(96.4％).结论 与BLUE方案比,M-BLUE方案能更准确地确定膈肌点位置,提高肺部病变诊断的准确性,更适用于重症患者.
目的 探討改良床徬肺部超聲(M-BLUE)方案與床徬肺部超聲(BLUE)方案膈肌點位置與徵象的差異.方法 選2015年1-2月連續入住北京協和醫院重癥醫學科的患者61例,分彆進行M-BLUE方案和BLUE方案檢查,比較兩種方案膈肌點檢查位置及超聲徵象的差異.結果 (1)M-BLUE方案與BLUE方案所確定的膈肌點的位置有47.5％ (58/122)存在差異,有18.0％(22/122)超聲徵象存在差異.(2)與BLUE方案比,閤併呼吸衰竭患者M-BLUE方案膈肌點位置的改變率[67.9％ (19/28)]和超聲徵象的改變率[42.9％ (12/28)]均高于未閤併呼吸衰竭患者[33.3％(11/33);12.1％ (4/33)].確診的5例急性呼吸窘迫綜閤徵(ARDS)和6例慢性阻塞性肺疾病(COPD)患者膈肌點位置均髮生改變,其中3例ARDS、4例COPD患者膈肌點徵象亦髮生改變.(3)閤併呼吸衰竭患者M-BLUE方案所確定的膈肌點的超聲徵象與胸部CT更為一緻(96.4％).結論 與BLUE方案比,M-BLUE方案能更準確地確定膈肌點位置,提高肺部病變診斷的準確性,更適用于重癥患者.
목적 탐토개량상방폐부초성(M-BLUE)방안여상방폐부초성(BLUE)방안격기점위치여정상적차이.방법 선2015년1-2월련속입주북경협화의원중증의학과적환자61례,분별진행M-BLUE방안화BLUE방안검사,비교량충방안격기점검사위치급초성정상적차이.결과 (1)M-BLUE방안여BLUE방안소학정적격기점적위치유47.5％ (58/122)존재차이,유18.0％(22/122)초성정상존재차이.(2)여BLUE방안비,합병호흡쇠갈환자M-BLUE방안격기점위치적개변솔[67.9％ (19/28)]화초성정상적개변솔[42.9％ (12/28)]균고우미합병호흡쇠갈환자[33.3％(11/33);12.1％ (4/33)].학진적5례급성호흡군박종합정(ARDS)화6례만성조새성폐질병(COPD)환자격기점위치균발생개변,기중3례ARDS、4례COPD환자격기점정상역발생개변.(3)합병호흡쇠갈환자M-BLUE방안소학정적격기점적초성정상여흉부CT경위일치(96.4％).결론 여BLUE방안비,M-BLUE방안능경준학지학정격기점위치,제고폐부병변진단적준학성,경괄용우중증환자.
Objective To investigate the differences of the locations and signs of the phrenic points between the Modified Bedside Lung Ultrasound Examination (M-BLUE)and Bedside Lung Ultrasound Examination (BLUE).Methods A total of 61 consecutive patients who were treated in the Department of Critical Care Medicine at Peking Union Medical College Hospital in January and February of 2015 were enrolled in this study.BLUE and M-BLUE were both performed on each patient.The differences of examination results were compared.Results (1) There were 47.5％ (58/122) different locations of the phrenic points and 18.0％ (22/122) different echo-signs between the BLUE protocol and the M-BLUE protocol.(2) Compared with BLUE protocol,changes of locations [67.9％ (19/28) vs 33.3％ (11/33)] and signs [42.9％ (12/28) vs 12.1％ (4/33)] of the phrenic points in the M-BLUE protocol in patients with respiratory failure were significantly higher than those without pulmonary diseases.Among 5 patients with acute respiratory distress syndrome and 6 patients with chronic obstructive pulmonary disease,all presented changes in locations of the phrenic point in the M-BLUE protocol,while 3 and 4 showed changes in signs respectively.(3) Signs of the phrenic point in the M-BLUE protocol were more consistent with the result of the chest CT than those in the BLUE protocol.Conclusion Compared with BLUE protocol,M-BLUE protocol seems more accurate in locating the phrenic point and more specific for the diagnosis of pulmonary disease.Compared with BLUE protocol,M-BLUE is more valuable for critical patients.
