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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
Fengxue Zhu, Xiujuan Zhao, Tianbing Wang, Zhenzhou Wang, Fuzheng Guo, Haiyan Xue, Panpan Chang, Hansheng Liang, Wentao Ni, Yaxin Wang, Lei Chen, Baoguo Jiang
工程（英文） ›› 2021, Vol. 7 ›› Issue (3) : 367-375.
PDF(924 KB)
PDF(924 KB)
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
Ultrasonic Characteristics and Severity Assessment of Lung Ultrasound in COVID-19 Pneumonia: A Retrospective, Observational Study
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。
The clinical application of lung ultrasound (LUS) in the assessment of coronavirus disease 2019 (COVID- 19) pneumonia severity remains limited. Herein, we investigated the role of LUS imaging in COVID-19 pneumonia patients and the relationship between LUS findings and disease severity. This was a retrospective, observational study at Tongji Hospital, on 48 recruited patients with COVID-19 pneumonia, including 32 non-critically ill patients and 16 critically ill patients. LUS was performed and the respiratory rate oxygenation (ROX) index, disease severity, and confusion, urea nitrogen, respiratory rate, blood pressure and age (CURB-65) score were recorded on days 0–7, 8–14, and 15–21 after symptom onset. Lung images were divided into 12 regions, and the LUS score (0–36 points) was calculated. Chest computed tomography (CT) scores (0–20 points) were also recorded on days 0–7. Correlations between the LUS score, ROX index, and CURB-65 scores were examined. LUS detected COVID-19 pneumonia in 38 patients. LUS signs included B lines (34/38, 89.5%), consolidations (6/38, 15.8%), and pleural effusions (2/38, 5.3%). Most cases showed more than one lesion (32/38, 84.2%) and involved both lungs (28/38, 73.7%). Compared with non-critically ill patients, the LUS scores of critically ill patients were higher (12 (10–18) vs 2 (0–5), p < 0.001). The LUS score showed significant negative correlations with the ROX index on days 0–7 (r = −0.85, p < 0.001), days 8–14 (r = −0.71, p < 0.001), and days 15–21 (r = −0.76, p < 0.001) after symptom onset. However, the LUS score was positively correlated with the CT score (r = 0.82, p < 0.001). The number of patients with LUS-detected lesions decreased from 27 cases (81.8%) to 20 cases (46.5%), and the LUS scores significantly decreased from 4 (2–10) to 0 (0–5) (p < 0.001) from days 0–7 to 17–21. We conclude that LUS can detect lung lesions in COVID-19 pneumonia patients in a portable, real-time, and safe manner. Thus, LUS is helpful in assessing COVID-19 pneumonia severity in critically ill patients.
Coronavirus disease 2019 / Lung ultrasound / Pneumonia
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