摘要
目的探讨肺部超声与X线胸片诊断急性呼吸窘迫综合征(ARDS)临床价值.方法收集ICU急性呼吸衰竭患者456例,同时行肺部超声及X线胸片检查,比较这两种方法诊断ARDS患者的特征、临床结果、ICU死亡率和住院死亡率.结果符合X线胸片诊断的患者216例(ICU死亡率19.4%,住院死亡率36.1%)、符合肺部超声诊断的229例患者(ICU死亡率22.7%,住院死亡率34.5%)和符合肺部超声但不符合X线胸片79例患者(ICU死亡率21.5%,住院死亡率29.1%)有相似结果.符合任一诊断的295例患者死亡率高于不符合任一诊断的161例患者(ICU死亡率20.0%?vs.12.4%,P=0.041;住院死亡率34.2%vs.24.2%,P=0.027).肺部超声的阳性预测值为0.66(95%置信区间0.59~0.72),阴性预测值为0.71(0.65~0.77).结论肺部超声有助于识别较高死亡风险的患者,肺部超声结合X线胸片可更精准的诊断ARDS患者.
Objective To analyze the clinical outcomes of ARDS diagnosed according to the Berlin Definition,using either chest radiography(Berlin-CXR)or lung ultrasound(Berlin-LUS)as an alternative imaging method.Methods This was a retrospective observational study in a 36-bed medical intensive care unit(ICU).Patients who required noninvasive ventilation or invasive ventilation for hypoxemic respiratory failure on ICU admission from August 2014 to March 2017 were included.Both chest radiography and lung ultrasound were performed routinely upon ICU admission.Comparisons were made using either the Berlin-CXR or Berlin-LUS definitions to diagnose ARDS with respect to the patient characteristics and clinical outcomes for each definition.ICU and hospital mortality were the main outcome measures for both definitions.Results The first admissions of 456 distinct patients were analyzed.Compared with the 216 patients who met the Berlin-CXR definition(ICU mortality 19.4%,hospital mortality 36.1%),229 patients who met the Berlin-LUS definition(ICU mortality 22.7%,hospital mortality 34.5%)and 79 patients who met the Berlin-LUS but not the Berlin-CXR definition(ICU mortality 21.5%,hospital mortality 29.1%)had similar outcomes.In contrast,the 295 patients who met either definition had higher mortality than the 161 patients who did not meet either definition(ICU mortality 20.0%versus 12.4%,P=0.041,hospital mortality 34.2%versus 24.2%,P=0.027).Compared with Berlin-CXR,Berlin-LUS had a positive predictive value of 0.66(95%confidence interval 0.59-0.72)and a negative predictive value of 0.71(0.65~0.77).Among the 216 Berlin-CXR ARDS patients,150 patients(69.4%)also fulfilled Berlin-LUS definition.Conclusions For the identification of ARDS using the Berlin definition,both chest radiography and lung ultrasound are equally related to mortality.The Berlin definition using lung ultrasound helps identify patients at higher risk of death,even if these patients do not fulfill the conventional Berlin definition using chest radiography.However,the moderate overlap of patients when chest imaging modalities differed suggests that chest radiography and lung ultrasound should be complementary rather than used interchangeably.
出处
《浙江临床医学》
2020年第1期120-122,共3页
Zhejiang Clinical Medical Journal
基金
浙江省医药卫生科技项目(2017KY181)。
关键词
急性呼吸窘迫综合症
肺部超声
X线胸片
Acute Respiratory
Distress Syndrome
Lung radiography
Lung ultrasonography
