床旁心肺超聲在心力衰竭合并肺水腫患者中的應(yīng)用

彭貴平　洪濤　梁敏　徐素音　周世云　李智惠　葉扶于

[關(guān)鍵詞] 肺超聲;心力衰竭;肺水腫;超聲心動圖

[中圖分類號] R541.6? ? ? ? ? [文獻標識碼] B? ? ? ? ? [文章編號] 1673-9701（2021）22-0136-04

Application of bedside cardiopulmonary ultrasound in patients with heart failure and pulmonary edema

PENG Guiping? ?HONG Tao? ?LIANG Min? ?XU Suyin? ?ZHOU Shiyun? ?LI Zhihui? ?YE Fuyu

Department of Ultrasound， Jiujiang NO.1 People's Hospital in Jiangxi Province， Jiujiang? ?332000，China

[Abstract] Objective To explore the clinical application of bedside cardiopulmonary ultrasound in patients with heart failure and pulmonary edema. Methods Forty patients with congestive heart failure admitted to the intensive care unit or emergency ward of our hospital between May 2019 and August 2020 were selected. All patients were examined by bedside cardiopulmonary ultrasound. Results The ultrasound pulmonary edema score was tested for patients with heart failure （NYHA） with heart function above grade Ⅱ. All patients were involved in bilateral diffuse B lines. The average examination time for patients was （3.0±0.3）min. The median of the B-line score of the 7-zone method was 11 points. The pulmonary edema score of heart failure （NYHA） patients with heart function above grade Ⅱ was diagnosed by ultrasound. It was found that the diagnostic value was 12.4.The sensitivity under this value could reach 80.78%，and the specificity was 60.24%. Multivariate regression analysis showed that among the risk factors of heart failure patients with pulmonary edema，the independent risk factors included average E/e'， SPAP， NT-proBNP. Conclusion Bedside pulmonary ultrasound is currently an effective method for clinical evaluation of patients with heart failure and pulmonary edema. At the same time，it has the advantages of simple operation method and relatively fast evaluation speed. Therefore， pulmonary ultrasound can become an important index for clinical rapid prediction and prognosis assessment of heart failure complicated with pulmonary edema.

[Key words] Lung ultrasound; Heart failure; Pulmonary edema; Echocardiography

急性心力衰竭是臨床上較為常見的一種疾病，病情較為嚴重，會嚴重影響患者的生命安全，心力衰竭是多種病因?qū)е碌幕颊叱霈F(xiàn)心臟收縮或舒張功能障礙，導(dǎo)致患者肺循環(huán)、體循環(huán)或者心臟循環(huán)出現(xiàn)障礙的綜合征[1]。在患者進行肺循環(huán)時，由于會出現(xiàn)一系列的障礙，其中較為關(guān)鍵的因素之一是肺水腫，肺水腫在患者的臨床診斷或早期的就診中作為心力衰竭治療的一個重要依據(jù)，如果能早期診斷可以有效的提升患者的預(yù)后和生存質(zhì)量[2]。本文主要用肺部超聲對心力衰竭合并肺水腫的患者進行臨床研究，旨為患者的臨床治療提供更好的依據(jù)，現(xiàn)報道如下。

1 資料與方法

1.1? 一般資料

本研究選取本院重癥監(jiān)護室或急診病房2019年5月至2020年8月間根據(jù)Framingham的標準診斷40例住院的充血性心力衰竭患者，所有患者均有不同程度的呼吸困難，美國紐約心臟病協(xié)會（New York heart association，NYHA）心功能分類分為NYHAⅡ，NYHAⅢ和NYHAIV。房顫、二尖瓣狹窄患者被排除在外。排除肺部疾病主要取決于臨床癥狀，胸部X光片和實驗室檢查。本研究獲得本院醫(yī)學(xué)倫理委員會的批準。參與研究的患者及家屬均簽署知情同意書。