肺超声在静脉-静脉体外膜肺患者行俯卧位通气治疗中的应用价值

彭誉; 李佳

doi:10.13201/j.issn.1009-5918.2021.09.007

肺超声在静脉-静脉体外膜肺患者行俯卧位通气治疗中的应用价值

彭誉,
李佳^,

- 南京医科大学附属苏州医院急诊与重症医学科(江苏苏州,215001)
基金项目:
苏州市科技兴卫青年项目(No:KJXW2016032)

详细信息

通讯作者: 李佳,E-mail:522904430@qq.com

中图分类号: R459.7

收稿日期: 2021-06-19

Application value of lung utrasonography in prone position ventilation treatment of vein vein extra corporeal membrane oxygenation patients

PENG Yu,
LI Jia^,

- Department of Emergency and Critical Care Medicine, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, 215001, China

More Information

Corresponding author: LI Jia, E-mail: 522904430@qq.com

Received Date: 19 June 2021

摘要

摘要: 目的:探讨肺超声(LUS)在评估静脉-静脉体外膜肺氧合(V-V ECMO)患者行俯卧位通气(PPV)后效果的临床价值。方法:收集2016年1月-2019年12月期间南京医科大学附属苏州医院重症医学科收治的同时行V-V ECMO和PPV治疗的急性呼吸窘迫综合征(ARDS)患者,共纳入患者18例,收集患者的临床基线资料。比较患者PPV前后肺静态顺应性(Cst),氧合指数(OI)、胸部CT图像变化和LUS评分。采用Pearson相关分析探讨LUS评分与OI、Cst相关性。对比分析,LUS评分替代胸部CT的可行性。ROC曲线计算LUS评分预测重度ARDS需行ECMO治疗的敏感度、特异度。结果:ARDS患者行V-V ECMO治疗过程中,辅助PPV治疗后,患者OI和Cst较PPV治疗前明显升高(均P<0.05),而两次PPV治疗后LUS评分较PPV治疗前明显降低(均P<0.05)。Spearman相关分析显示,LUS评分与OI、Cst分别呈负相关,相关系数分别为-0.551、-0.678。LUS评分与胸部CT影像分析得出,16例患者CT影像学和患者LUS评分相符,2例与LUS评分相左,超声诊断准确率92.8%。ROC曲线分析,LUS评分以26分为阈值判断ARDS患者是否需要V-V ECMO治疗曲线下面积为0.930,敏感度为89.1%,特异度为79.3%。结论:LUS评分可评估V-V ECMO患者PPV前后肺部变化情况,能预测重度ARDS是否需行ECMO治疗,具有极高的临床应用价值。
- 肺超声 /
- 体外膜肺氧合 /
- 急性呼吸窘迫综合征 /
- 俯卧位通气
Abstract: Objective: To explore the application value of lung utrasonography(LUS)in the effect evaluation of vein vein extra corporeal membrane oxygenation(V-V ECMO)patients after prone position ventilation(PPV).Methods: The acute respiratory distress syndrome(ARDS) patients with V-V ECMO and PPV treatments who were admitted to the Department of Critical Care Medicine, Suzhou Hospital Affiliated to Nanjing Medical University from January 2016 to December 2019 were collected. A total of 18 patients were enrolled, and clinical baseline data of the patients were collected. The lung dynamic compliance(Crs, mL/cmH₂O), oxygenation index(OI), chest CT image changes and LUS score were compared before and after PPV. Pearson correlation analysis was used to explore the correlation between LUS score with OI and Crs. Comparative analysis was used to analyze the feasibility of LUS score to replace chest CT. The sensitivity and specificity of LUS score to predict ECMO treatment for severe ARDS were calculated by ROC curve.Results: In ARDS patients undergoing V-V ECMO treatment, after adjuvant PPV treatment, the patient's oxygenation index and Crs were significantly higher than those before PPV treatment(both P<0.05), while LUS score was significantly lower than that before PPV( P<0.05). Spearman correlation analysis showed that the LUS score was negatively correlated with OI and Crs, and the correlation coefficients were-0.557 and-0.678,respectively. According to the analysis of LUS score and chest CT imaging, 16 patients' CT imaging was consistent with their LUS score, and that of 2 cases was not. The accuracy of ultrasound diagnosis was 91.3%, with 81.2% of sensitivity and 90.4% of specificity. Taking 26 points as cut-off value, the area under the curve of the LUS score for determining whether ARDS patients need V-V ECMO treatment is 0.930, with 89.1% of sensitivity and 79.3% of specificity.Conclusion: LUS score is simple and easy to implement. It can effectively assesses the changes lung conditions before and after PPV in the lungs of patients with V-V ECMO patients before ECMO, and after PPV. It can replace the chest CT to assess the severity of lung lesions in patients and predict whether severe ARDS needs ECMO treatment. It, which has extremely high clinical application value.
- lung utrasonography /
- extra corporeal membrane oxygenation /
- acute respiratory distress syndrome /
- prone position ventilation

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