| 摘要: |
| 【】目的：探讨床旁肺部超声评价ARDS患者的肺水肿以及指导肺部治疗在急性呼吸窘迫综合征(ARDS)患者救治中的应用价值。方法: 收集上海市第七人民医院重症医学科收治的60例ARDS患者的临床资料进行分析,随机分为两组,肺部超声组和对照组,每组各30例患者。收集患者性别、年龄、病因,记录患者入科时及第7天的相关数据, APACHE II评分、SOFA评分WBC、CRP、PCT、血管外肺水指数、氧合指数、中心静脉压、机械通气治疗时间,肺部超声组收集肺部超声评分,两组患者的7天好转率、ICU住院时间、28天死亡率。研究：肺部超声在评估患者病情危重程度、治疗过程、预测预后的价值,以及肺部超声评分与血管外肺水指数等的相关性。结果: ①两组在治疗前的APACHEⅡ评分、SOFA评分、氧合指数、血管外肺水指数、WBC、CRP、PCT无明显统计学差异(P>0.05),治疗7日后两组患者治疗后均有改善,肺部超声组改善更明显,且机械通气时间更短(P<0.05)。②两组患者治疗前中心静脉压(CVP)无明显差异,治疗7日后两组患者的CVP无明显差异(P>0.05)③肺部超声组患者7日好转率较对照组高,入住ICU时间较对照组缩短,28天死亡率肺部超声组比对照组低(P<0.05)。④所有患者治疗前后患者的血管外肺水指数与APACHE Ⅱ评分、血管外肺水指数、中心静脉压均呈正相关,与氧合指数呈负相关。⑤肺部超声组肺部超声评分与APACHE Ⅱ评分、SOFA评分、血管外肺水指数均呈正相关,肺部超声评分与中心静脉压呈正相关,肺部超声评分与与氧合指数呈负相关。结论：肺部超声在急性呼吸窘迫综合征患者中能有效评估患者的严重程度,指导ARDS患者的个体化治疗,预测患者预后,可作为重症监护室ARDS患者的常规诊疗方法。 |
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| DOI： |
| 投稿时间：2019-02-28修订日期：2019-06-06 |
| 基金项目:]: 上海市卫生和计划生育委员会中医特色诊疗技术提升项目(zyjx-2017021)；上海市浦东新区卫生和计划生育委员会临床高原学科建设(PWYgy2018-01)；上海中医药大学附属第七人民医院人才培养项目 |
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| Application value of bedside pulmonary ultrasound in patients with acute respiratory distress syndrome |
| YaoYuLong |
| () |
| Abstract: |
| 【】Objective: To evaluate the value of bedside pulmonary ultrasound in evaluating pulmonary edema in patients with ARDS and guiding lung therapy in the treatment of patients with acute respiratory distress syndrome (ARDS). Methods: The clinical data of 60 patients with ARDS admitted to the Department of Critical Care Medicine, Shanghai Seventh People"s Hospital were collected and randomly divided into two groups: pulmonary ultrasound group and control group, with 30 patients in each group. The patient"s gender, age, and etiology were collected. The data of the patient"s admission and the 7th day were recorded. APACHE II score, SOFA score WBC, CRP, PCT, extravascular lung water index, oxygenation index, central venous pressure, mechanical ventilation At the time, the pulmonary ultrasound group collected pulmonary ultrasound scores, 7-day improvement rate, ICU hospitalization time, and 28-day mortality in both groups. Study: The value of pulmonary ultrasound in assessing the severity of the patient"s condition, the duration of the treatment, predicting the prognosis, and the correlation between the pulmonary ultrasound score and the extravascular lung water index. Results: 1 There was no significant difference in APACHE II score, SOFA score, oxygenation index, extravascular lung water index, WBC, CRP and PCT between the two groups before treatment (P>0.05). After 7 days of treatment, both groups of patients were treated after treatment. There was improvement, the improvement of the pulmonary ultrasound group was more obvious, and the mechanical ventilation time was shorter (P<0.05). There was no significant difference in the pre-treatment central venous pressure (CVP) between the two groups. There was no significant difference in CVP between the two groups after 7 days of treatment (P>0.05). The improvement rate of the 7-day ultrasound in the pulmonary ultrasound group was higher than that in the control group. Compared with the control group, the 28-day mortality in the pulmonary ultrasound group was lower than that in the control group (P<0.05). 4 The extravascular lung water index of all patients before and after treatment was positively correlated with APACHE II score, extravascular lung water index and central venous pressure, and negatively correlated with oxygenation index. 5 Pulmonary ultrasound scores in the pulmonary ultrasound group were positively correlated with APACHE II score, SOFA score, and extravascular lung water index. Pulmonary ultrasound score was positively correlated with central venous pressure, and pulmonary ultrasound score was negatively correlated with oxygenation index. Conclusion: Pulmonary ultrasound can effectively assess the severity of patients in patients with acute respiratory distress syndrome, guide individualized treatment of patients with ARDS, and predict the prognosis of patients. It can be used as a routine diagnosis and treatment method for patients with ARDS in intensive care unit. |
| Key words: : Pulmonary Ultrasound Pulmonary Edema Acute Respiratory Distress Syndrome |
