摘要
目的 探讨床旁超声联合超声心动图在快速鉴别诊断心源性呼吸困难(CD)与肺源性呼吸困难(PD)中的价值.方法 将2020年2月至2023年2月马鞍山十七冶医院收治的100例急性呼吸困难患者纳入本次回顾性研究,根据病因不同分为PD组(n=41)和CD组(n=59).两组患者均在入院当天接受床旁超声检查和超声心动图检查,收集和比较两组床旁超声检查和超声心动图检查指标[B线总数、左室舒张末期内径(LVEDD)、左心房内径(LA)、二尖瓣口舒张早期血流速度(E)与二尖瓣环舒张早期运动速度(e')之比(E/e')、左心室射血分数(LVEF)]和血清N末端脑钠肽(NT-proBNP);以综合诊断结果结果为"金标准",计算床旁超声联合超声心动图的诊断符合率;采用Pearson相关性分析B线总数与LVEDD、LA、E/e'、LVEF、血清NT-proBNP的相关性.结果 床旁超声联合超声心动图诊断CD的符合率为93.22％(47/51),诊断PD的符合率为90.24％(37/41),漏诊率为8.00％(8/100).CD组的B线总数、LVEDD、LA、E/e'、血清 NT-proBNP 分别为(18.85±3.58)条、(55.03±2.09)mm、(42.39±2.44)mm、16.83±2.54、(3 998.54±598.17)ng/L,均显著高于 PD 组[(7.02±2.31)条、(46.75±1.80)mm、(34.70±2.13)mm、7.42±1.96、(595.07±230.71)ng/L],而 CD 组的 LVEE 为(42.98±3.04)％,显著低于 PD 组[(60.76±2.83)％],差异均有统计学意义(P＜0.05).B 线总数与 LVEDD、LA、E/e'、NT-proBNP 呈线性正相关(r=0.692、0.711、0.571、0.455,P＜0.05),与LVEF呈负相关(r=-0.892,P＜0.05).结论 床旁超声联合超声心动图在CD/PD中的诊断符合率较高,且在快速鉴别诊断急性呼吸困难病因中有较高的应用价值.
Abstract
Objective To explore the application value of bedside ultrasound combined with echocardiography in the rapid differential di-agnosis of cardiogenic dyspnea(CD)and pulmonary dyspnea(PD).Methods A total of 100 patients with acute respiratory distress admitted to Maanshan Seventeen Metallurgical Hospital from February 2020 to February 2023 were included in this retrospective study.According to the differ-ent etiologies,they were divided into the PD group(n=41)and the CD group(n=59).Both groups of patients underwent bedside ultrasound and echocardiography on the same day of admission.The bedside ultrasound and echocardiography related indexes The total number of B lines,left ventricular end-diastolic diameter(LVEDD),left atrial diameter(LA),the ratio of early diastolic mitral flow velocity(E)to early diastolic mi-tral annulus velocity(e')(E/e'),left ventricular ejection fraction(LVEF)],and serum N-terminal pro-brain natriuretic peptide(NT-proB-NP)detected by enzyme linked immunosorbent assaywere collected and compared.The diagnostic accordance rate of bedside ultrasound combina-tion with echocardiography was calculated using the comprehensive diagnostic results as the"gold standard".The correlation of the total number of B-lines with LA,LVEDD,LVEF,E/e'and serum NT-proBNP were analyzed by Pearson correlation analysis.Results The diagnostic accord-ance rate of bedside ultrasound combined with echocardiography for CD was 93.22％(47/51),and the diagnostic accordance rate for PD was 90.24％(37/41),with a missed diagnosis rate of 8.00％(8/100).The the total number of B-lines,LVEDD,LA,E/e',and serum NT-proBNP in the CD group were(18.85±3.58)bands,(55.03±2.09)mm,(42.39±2.44)mm,16.83±2.54,and(3 998.54±598.17)ng/L,respectively,which were much higher than those in the PD group[(7.02±2.31)bands,(46.75±1.80)mm,(34.70±2.13)mm,7.42±1.96,and(595.07±230.71)ng/L],the LVEF in the CD group was(42.98±3.04)％,which was lower than that in the PD group[(60.76±2.83)％],the differences were statistically significant(P＜0.05).There was a positive correlation between the total number of B-lines and LVEDD,LA,E/e',and NT-proBNP(r=0.692,0.711,0.455,0.571,P＜0.05),and a negative association with LVEF(r=-0.892,P＜0.05).Conclusion Bedside ultrasound combination with echocardiography has a high diagnostic accordance rate in CD/PD and it has high application value in quickly distinguishing and diagnosing the causes of acute respiratory distress.
维普
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