研究肺部超声监测B线数目评估重症患者血管外肺水的价值
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摘要
目的:探讨肺部超声监测B线数目评估重症住院患者血管外肺水的价值,并分析肺部超声B线数目与血管外肺水相关性。方法:选取2015年5月-2017年5月本院收治的62例重症住院患者为主要研究对象,采用肺部超声采集治疗前后的B线数目,采用脉搏指数连续心排血量(PICCO)监测血管外肺水指数。将治疗前后的肺部超声B线数目、血管外肺水指数以及氧合指数的变化情况进行对比,评价肺部超声B线数目与血管外肺水的相关性。结果:经治疗后,所有患者的B线数目(9.18±3.23)、血管外肺水指数(7.96±2.24)m L/kg均明显低于治疗前,差异均有统计学意义(P<0.05);氧合指数(316.65±65.33)mm Hg明显高于治疗前,差异有统计学意义(P<0.05)。经双变量相关性分析,B线数目与血管外肺水呈正相关(r=-0.503,P=0.027),与氧合指数呈负相关(r=0.807,P=0.001)。结论:经肺部超声获得的B线数目与采用PICCO监测获得的血管外肺水之间存在良好的相关性,因此,肺部超声可以用于评价检测血管外肺水,以早期发现外肺水,同时肺部超声可以用于评价临床治疗效果,值得在临床上进一步应用和推广。
Objective:To explore the value of pulmonary ultrasound monitoring B line number in evaluating the extravascular pulmonary water in patients with severe hospitalization and analyze the correlation between the number of pulmonary ultrasound B line number and extravascular pulmonary water.Method:A total of 62 severe inpatient admitted in our hospital from May 2015 to May 2017 were selected as the main study subjects.The number of B lines before and after treatment were collected by pulmonary ultrasound,and the extravascular pulmonary water index was monitored by pulse index continuous cardiac output(PICCO).The changes of the number of pulmonary ultrasound B lines,the extravascular pulmonary water index and the oxygenation index before and after the treatment were compared,the correlation between the number of pulmonary ultrasound B lines and extravascular pulmonary water was analyzed.Result:After treatment,the number of B lines was(9.18±3.23)and extravascular pulmonary water index was(7.96±2.24)m L/kg in all patients,which were significantly lower than those of before treatment,the differences were statistically significant(P<0.05);the oxygenation index was(316.65±65.33)mm Hg,which was significantly higher than that of before treatment,the difference was statistically significant(P<0.05).Bivariate correlation analysis showed that the number of B lines was positively correlated with extravascular pulmonary water(r=-0.503,P=0.027)and negatively correlated with oxygenation index(r=0.807,P=0.001).Conclusion:There is a good correlation between the number of B lines obtained by pulmonary ultrasound and extravascular pulmonary water obtained by PICCO monitoring.Pulmonary ultrasound can be used to evaluate and detect extravascular pulmonary water in order to detect it early,and can be used to evaluate the clinical therapeutic effect,which is worthy of further application and promotion in clinic.
Objective:To explore the value of pulmonary ultrasound monitoring B line number in evaluating the extravascular pulmonary water in patients with severe hospitalization and analyze the correlation between the number of pulmonary ultrasound B line number and extravascular pulmonary water.Method:A total of 62 severe inpatient admitted in our hospital from May 2015 to May 2017 were selected as the main study subjects.The number of B lines before and after treatment were collected by pulmonary ultrasound,and the extravascular pulmonary water index was monitored by pulse index continuous cardiac output(PICCO).The changes of the number of pulmonary ultrasound B lines,the extravascular pulmonary water index and the oxygenation index before and after the treatment were compared,the correlation between the number of pulmonary ultrasound B lines and extravascular pulmonary water was analyzed.Result:After treatment,the number of B lines was(9.18±3.23)and extravascular pulmonary water index was(7.96±2.24)m L/kg in all patients,which were significantly lower than those of before treatment,the differences were statistically significant(P<0.05);the oxygenation index was(316.65±65.33)mm Hg,which was significantly higher than that of before treatment,the difference was statistically significant(P<0.05).Bivariate correlation analysis showed that the number of B lines was positively correlated with extravascular pulmonary water(r=-0.503,P=0.027)and negatively correlated with oxygenation index(r=0.807,P=0.001).Conclusion:There is a good correlation between the number of B lines obtained by pulmonary ultrasound and extravascular pulmonary water obtained by PICCO monitoring.Pulmonary ultrasound can be used to evaluate and detect extravascular pulmonary water in order to detect it early,and can be used to evaluate the clinical therapeutic effect,which is worthy of further application and promotion in clinic.
引文
[1]陈卫挺,陶福正,陈仁辉,等.肺部超声B线数目与血管外肺水及ARDS严重程度的相关性分析[J].浙江临床医学,2017,19(8):1428-1430.
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[3]郑清江,陈林丽,赖嘉伟,等.不同类别肺水肿在肺部超声中B线的对比[J].中国医药指南,2017,15(9):7-8.
[4]陈怀生,张华东,洪澄英,等.床旁实时超声指导中重度急性呼吸窘迫综合征后期液体调控的价值研究[J].实用心脑肺血管病杂志,2014,22(5):99-100.
[5]方明星,刘娜,郭建英,等.乌司他丁对肝移植术后肺血管通透性的影响[J].临床荟萃,2015,30(7):814-817.
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[7]于红奎,李志惠,丁以群,等.超声心动图肺评分评价先天性心脏病患儿血管外肺水的可行性研究[J].临床超声医学杂志,2017,19(5):297-300.
[8]周树生,查渝,王春艳,等.床旁超声技术对慢性阻塞性肺疾病及心源性肺水肿的诊断价值研究[J].中华危重病急救医学,2014,26(8):558-562.
[9]吴文,聂昆.心源性呼吸困难的诊断新策略-肺部超声“彗尾征”[J].中国全科医学,2015,15(33):4114-4118.
[10]庄水龙.床旁超声半定量监测血管外肺水联合下腔静脉宽度在老年脓毒性休克患者早期液体复苏治疗中的应用价值[J].世界临床医学,2016,10(23):8-9.
[11]朱维维,李一丹,李虹,等.间质性肺疾病肺超声表现与心脏受累程度之间的相关性研究[J].中华超声影像学杂志,2016,25(9):743-749.
[12]茹翱,季政,汤莹,等.肺超声在心源性肺水肿诊疗中的应用价值[J].医学研究杂志,2015,44(12):142-144.
[13]黄向红,韦丽思,黄小莉.间质性肺疾病患者肺超声评分与肺功能相关性的初步探讨[J].中国临床医学影像杂志,2017,28(3):184-187.
[14]王加伟,卢来顺,王良玉,等.腹膜透析患者肺淤血危险因素分析及肺超声对其容量状态的评估价值[J].广东医学,2017,38(6):864-867.
[15]张智慧,阚艳敏,马琳,等.床旁肺超声快速鉴别诊断老年人心源性呼吸困难的价值[J].中国临床医学影像杂志,2016,27(6):397-399.
[16]卢玉婵,周显礼.经胸肺超声B线的研究[J].临床肺科杂志,2017,22(4):739-742.
[17]唐菊,陈文娟,周梦洁,等.肺超声评分对新生儿呼吸窘迫综合征诊断价值的研究[J].中国临床医学影像杂志,2016,27(4):263-266.
[18]廖玉苹,周炳元,杨俊华.床旁肺部超声联合血浆氨基末端脑钠肽前体对心力衰竭的诊断价值[J].临床心血管病杂志,2017,8(1):58-61.
[19]张红霞,谢江柳,罗晓静.肺超声动态监测评估重症休克患者容量复苏效果的价值分析[J].实用临床医药杂志,2017,21(5):36-38.
[20]王敏佳,龚仕金,严静,等.肺部超声B线数目与血管外肺水的相关性分析[J].浙江医学,2016,38(2):109-111.
[21]张伟,杨静.重症超声B线与血管外肺水分析[J].全文版:医药卫生,2016(1):259.
[22]赵振,姜利,朱波,等.肺超声彗星尾征对急性呼吸窘迫综合征血管外肺水判定与评估[J].中国实用内科杂志,2017,37(8):722-725.
[23]马德花,鲍海咏,张宏,等.肺部超声监测在严重高原肺水肿中的应用[J].中华危重病急救医学,2017,29(9):815-820.
[2]傅小云,高飞,苏德,等.重症患者肺超声B线评分用于血管外肺水评估的临床研究[J].中国急救医学,2014,34(7):591-594.
[3]郑清江,陈林丽,赖嘉伟,等.不同类别肺水肿在肺部超声中B线的对比[J].中国医药指南,2017,15(9):7-8.
[4]陈怀生,张华东,洪澄英,等.床旁实时超声指导中重度急性呼吸窘迫综合征后期液体调控的价值研究[J].实用心脑肺血管病杂志,2014,22(5):99-100.
[5]方明星,刘娜,郭建英,等.乌司他丁对肝移植术后肺血管通透性的影响[J].临床荟萃,2015,30(7):814-817.
[6]武钧,钟鸣,吴璟奕,等.重症急性胰腺炎液体复苏时血管外肺水和胸腔积液变化:肺部超声研究[J].外科理论与实践,2015,10(2):135-140.
[7]于红奎,李志惠,丁以群,等.超声心动图肺评分评价先天性心脏病患儿血管外肺水的可行性研究[J].临床超声医学杂志,2017,19(5):297-300.
[8]周树生,查渝,王春艳,等.床旁超声技术对慢性阻塞性肺疾病及心源性肺水肿的诊断价值研究[J].中华危重病急救医学,2014,26(8):558-562.
[9]吴文,聂昆.心源性呼吸困难的诊断新策略-肺部超声“彗尾征”[J].中国全科医学,2015,15(33):4114-4118.
[10]庄水龙.床旁超声半定量监测血管外肺水联合下腔静脉宽度在老年脓毒性休克患者早期液体复苏治疗中的应用价值[J].世界临床医学,2016,10(23):8-9.
[11]朱维维,李一丹,李虹,等.间质性肺疾病肺超声表现与心脏受累程度之间的相关性研究[J].中华超声影像学杂志,2016,25(9):743-749.
[12]茹翱,季政,汤莹,等.肺超声在心源性肺水肿诊疗中的应用价值[J].医学研究杂志,2015,44(12):142-144.
[13]黄向红,韦丽思,黄小莉.间质性肺疾病患者肺超声评分与肺功能相关性的初步探讨[J].中国临床医学影像杂志,2017,28(3):184-187.
[14]王加伟,卢来顺,王良玉,等.腹膜透析患者肺淤血危险因素分析及肺超声对其容量状态的评估价值[J].广东医学,2017,38(6):864-867.
[15]张智慧,阚艳敏,马琳,等.床旁肺超声快速鉴别诊断老年人心源性呼吸困难的价值[J].中国临床医学影像杂志,2016,27(6):397-399.
[16]卢玉婵,周显礼.经胸肺超声B线的研究[J].临床肺科杂志,2017,22(4):739-742.
[17]唐菊,陈文娟,周梦洁,等.肺超声评分对新生儿呼吸窘迫综合征诊断价值的研究[J].中国临床医学影像杂志,2016,27(4):263-266.
[18]廖玉苹,周炳元,杨俊华.床旁肺部超声联合血浆氨基末端脑钠肽前体对心力衰竭的诊断价值[J].临床心血管病杂志,2017,8(1):58-61.
[19]张红霞,谢江柳,罗晓静.肺超声动态监测评估重症休克患者容量复苏效果的价值分析[J].实用临床医药杂志,2017,21(5):36-38.
[20]王敏佳,龚仕金,严静,等.肺部超声B线数目与血管外肺水的相关性分析[J].浙江医学,2016,38(2):109-111.
[21]张伟,杨静.重症超声B线与血管外肺水分析[J].全文版:医药卫生,2016(1):259.
[22]赵振,姜利,朱波,等.肺超声彗星尾征对急性呼吸窘迫综合征血管外肺水判定与评估[J].中国实用内科杂志,2017,37(8):722-725.
[23]马德花,鲍海咏,张宏,等.肺部超声监测在严重高原肺水肿中的应用[J].中华危重病急救医学,2017,29(9):815-820.