期刊首页 优先出版 当期阅读 过刊浏览 作者中心 关于期刊 English

《工程(英文)》 >> 2021年 第7卷 第3期 doi: 10.1016/j.eng.2020.09.007

新冠病毒肺炎肺部超声的特点及其在病情评估中的价值——一项回顾性观察研究

a Trauma Center, Critical Care Medicine Department, Peking University People's Hospital, Beijing 100044, China
b Trauma Center, Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Peking University People's Hospital, Beijing 100044, China
c Anesthesiology Department, Peking University People's Hospital, Beijing 100044, China
d Respiratory and Critical Care Medicine Department, Peking University People's Hospital, Beijing 100044, China
e Radiology Department, Peking University People's Hospital, Beijing 100044, China

# These authors contributed equally to this work.

收稿日期: 2020-04-09 修回日期: 2020-08-15 录用日期: 2020-09-06 发布日期: 2020-10-16

下一篇 上一篇

摘要

肺部超声(lung ultrasound, LUS)在新冠病毒肺炎(简称新冠肺炎)病情严重程度评估中的价值不明确。本研究旨在探讨新冠肺炎的LUS影像学特征,并分析LUS征象与新冠肺炎疾病严重程度的关系。本研究为在同济医院进行的一项回顾性观察研究,连续入选48例新冠肺炎患者,并将其分为32例非危重患者和16例危重患者。出现症状后0~7 d、8~14 d和15~21 d进行LUS检查并记录ROX(respiratory rate oxygenation)指数、疾病严重程度和CURB-65评分。根据LUS检查方案,将肺部分为12个区域,计算LUS评分(0~36分)。出现症状后0~7 d评估胸部计算机断层扫描(computed tomography, CT)评分(0~20分)。观察LUS评分与CURB-65和ROX指数的相关性。通过LUS发现新冠肺炎患者38例。新冠肺炎的LUS征象包括B线(34/38, 89.5%)、实变(6/38,15.8%)和胸腔积液(2/38, 5.3%)。多发病变(32/38, 84.2%)和双肺病变(28/38, 73.7%)较多。与非危重患者相比,危重患者的LUS评分更高[12 (10~18) vs 2 (0~5), p < 0.001]。LUS评分与出现症状后0~7 d(r = −0.85, p  <  0.001)、8~14 d(r  =  −0.71, p  <  0.001)和15~21 d(r  =  −0.76, p  <  0.001)的ROX指数负相关。LUS评分与CT评分为正相关(r  =  0.82,p  <  0.001)。从出现症状后0~7 d到17~21 d,通过LUS发现肺部病变的病例数从27例(81.8%)减少至20例(46.5%),LUS评分从4 (2~10)分明显降至0 (0~5) 分(p  <  0.001)。因此,LUS在新冠肺炎患者中能简便、实时、安全地检测肺部病变,LUS有助于在危重患者中评估新冠肺炎的严重程度。

图片

图1

图2

图3

图4

图5

参考文献

[ 1 ] WHO director—General’s opening remarks at the media briefing on COVID19—11 March 2020 [Internet]. Geneva: World Health Organization; 2020 Mar 11 [cited 2020 Aug 14]. Available from: https://www.who.int/dg/speeches/ detail/who-director-general-s-opening-remarks-at-the-media-briefing-oncovid-19—11-march-2020.. 链接1

[ 2 ] Coronavirus disease (COVID-19) situation report—207 [Internet]. Geneva: World Health Organization; 2020 Aug 14 [cited 2020 Aug 14]. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/ 20200814-covid-19-sitrep-207.pdf?sfvrsn=2f2154e6_2. 链接1

[ 3 ] Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395(10229):1054–62. 链接1

[ 4 ] Touw HR, Tuinman PR, Gelissen HP, Lust E, Elbers PW. Lung ultrasound: routine practice for the next generation of internists. Neth J Med 2015;73 (3):100–7. 链接1

[ 5 ] Pisani L, Vercesi V, van Tongeren PSI, Lagrand WK, Leopold SJ, Huson MAM, et al. The diagnostic accuracy for ARDS of global versus regional lung ultrasound scores—a post hoc analysis of an observational study in invasively ventilated ICU patients. Intensive Care Med Exp 2019;7(Suppl 1):44. 链接1

[ 6 ] Wang XT, Ding X, Zhang HM, Chen H, Su LX, Liu DW; Chinese Critical Ultrasound Study Group (CCUSG). Lung ultrasound can be used to predict the potential of prone positioning and assess prognosis in patients with acute respiratory distress syndrome. Crit Care 2016;20(1):385. 链接1

[ 7 ] Yin W, Zou T, Qin Y, Yang J, Li Y, Zeng X, et al. Chinese Critical Ultrasound Study Group (CCUSG). Poor lung ultrasound score in shock patients admitted to the ICU is associated with worse outcome. BMC Pulm Med 2019;19(1):1. 链接1

[ 8 ] Zhao Z, Jiang L, Xi X, Jiang Q, Zhu B, Wang M, et al. Prognostic value of extravascular lung water assessed with lung ultrasound score by chest sonography in patients with acute respiratory distress syndrome. BMC Pulm Med 2015;15(1):98. 链接1

[ 9 ] Sofia S, Boccatonda A, Montanari M, Spampinato M, D’ardes D, Cocco G, et al. Thoracic ultrasound and SARS–COVID-19: a pictorial essay. J Ultrasound 2020;23(2):217–21. 链接1

[10] Peng QY, Wang XT, Zhang LN; Chinese Critical Care Ultrasound Study Group (CCUSG). Findings of lung ultrasonography of novel corona virus pneumonia during the 2019–2020 epidemic. Intensive Care Med 2020;46(5):849–50. 链接1

[11] Xing C, Li Q, Du H, Kang W, Lian J, Yuan L. Lung ultrasound findings in patients with COVID-19 pneumonia. Crit Care 2020;24(1):174. 链接1

[12] Smith MJ, Hayward SA, Innes SM, Miller ASC. Point-of-care lung ultrasound in patients with COVID-19—a narrative review. Anaesthesia 2020;75 (8):1096–104. 链接1

[13] Vetrugno L, Bove T, Orso D, Barbariol F, Bassi F, Boero E, et al. Our Italian experience using lung ultrasound for identification, grading and serial followup of severity of lung involvement for management of patients with COVID19. Echocardiography 2020;37(4):625–7. 链接1

[14] Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007;370(9596):1453–7. 链接1

[15] Clinical management of COVID-19—interim guidance [Internet]. Geneva: World Health Organization; 2020 May 27 [cited 2020 Aug 14]. Available from: https://www.who.int/publications-detail/clinical-management-ofsevere-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infectionis-suspected. 链接1

[16] Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395 (10223):497–506. 链接1

[17] National Health Commission of the People’s Republic of China; State Administration of Traditional Chinese Medicine. Diagnosis and treatment protocol for novel coronavirus pneumonia (trial version 7). Beijing: National Health Commission of the People’s Republic of China; 2020 Mar 3 [cited 2020 Aug 14]. Available from: http://www.nhc.gov.cn/yzygj/s7653p/202003/ 46c9294a7dfe4cef80dc7f5912eb1989/files/ce3e6945832a438eaae415350a8ce 964.pdf. Chinese. 链接1

[18] Branson RD, Hess DR, Chatburn RL. Respiratory care equipment. Philadelphia: J.B. Lippincott Company; 1995. 链接1

[19] Roca O, Caralt B, Messika J, Samper M, Sztrymf B, Hernández G, et al. An index combining respiratory rate and oxygenation to predict outcome of nasal highflow therapy. Am J Respir Crit Care Med 2019;199(11):1368–76. 链接1

[20] Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003;58(5):377–82. 链接1

[21] cc-e-is.org [Internet]. Beijing: Chinese Critical Ultrasound Study Group; c2020 [cited 2020 Aug 14]. Available from: http://www.cc-e-is.org. 链接1

[22] Rouby JJ, Arbelot C, Gao Y, Zhang M, Lv J, An Y, et al. APECHO Study Group. Training for lung ultrasound score measurement in critically ill patients. Am J Respir Crit Care Med 2018;198(3):398–401. 链接1

[23] Li W, Fang Y, Liao J, Yu W, Yao L, Cui H, et al. Clinical and CT features of the COVID-19 infection: comparison among four different age groups. Eur Geriatr Med 2020. Epub 2020 Jul 13. 链接1

[24] Li K, Fang Y, Li W, Pan C, Qin P, Zhong Y, et al. CT image visual quantitative evaluation and clinical classification of coronavirus disease (COVID-19). Eur Radiol 2020;30(8):4407–16. 链接1

[25] Wang T, Du Z, Zhu F, Cao Z, An Y, Gao Y, et al. Comorbidities and multi-organ injuries in the treatment of COVID-19. Lancet 2020;395(10228):e52. 链接1

[26] Grasselli G, Pesenti A, Cecconi M. Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: early experience and forecast during an emergency response. JAMA 2020;323(16):1545. 链接1

[27] Brown LM, Calfee CS, Howard JP, Craig TR, Matthay MA, McAuley DF. Comparison of thermodilution measured extravascular lung water with chest radiographic assessment of pulmonary oedema in patients with acute lung injury. Ann Intensive Care 2013;3(1):25. 链接1

[28] Cho YJ, Song KH, Lee Y, Yoon JH, Park JY, Jung J, et al. Lung ultrasound for early diagnosis and severity assessment of pneumonia in patients with coronavirus disease 2019. Korean J Intern Med 2020;35(4):771–81. 链接1

[29] Dargent A, Chatelain E, Kreitmann L, Quenot JP, Cour M, Argaud L, et al. Lung ultrasound score to monitor COVID-19 pneumonia progression in patients with ARDS. PLoS One 2020;15(7):e0236312. 链接1

[30] Volpicelli G, Lamorte A, Villén T. What’s new in lung ultrasound during the COVID-19 pandemic. Intensive Care Med 2020;46(7):1445–8. 链接1

[31] Shi H, Han X, Jiang N, Cao Y, Alwalid O, Gu J, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis 2020;20(4):425–34. 链接1

[32] Liu Q, Wang RS, Qu GQ, Wang YY, Liu P, Zhu YZ, et al. Gross examination report of a COVID-19 death autopsy. J Forensic Med 2020;36(1):21–3. 链接1

[33] Wang R, Sun H, Song L, Song W, Cui H, Li B, et al. Plain radiograph and CT features of 112 patients with SARS in acute stage. J Peking Univ (Health Sci) 2003;35(Suppl):29–33. Chinese. 链接1

[34] Chiumello D, Umbrello M, Sferrazza Papa GF, Angileri A, Gurgitano M, Formenti P, et al. Global and regional diagnostic accuracy of lung ultrasound compared to CT in patients with acute respiratory distress syndrome. Crit Care Med 2019;47(11):1599–606. 链接1

[35] Tierney DM, Huelster JS, Overgaard JD, Plunkett MB, Boland LL, St Hill CA, et al. Comparative performance of pulmonary ultrasound, chest radiograph, and CT among patients with acute respiratory failure. Crit Care Med 2020;48(2):151–7. 链接1

[36] Li L, Yang Q, Li L, Guan J, Liu Z, Han J, et al. The value of lung ultrasound score on evaluating clinical severity and prognosis in patients with acute respiratory distress syndrome. Chin Crit Care Med 2015;27(7):579–84. Chinese. 链接1

相关研究