摘要
目的 比较改良BLUE方案肺超声评分与传统区域评分法在机械通气患者中的应用优劣,探讨改良BLUE方案与序贯器官衰竭评估(SOFA)评分、氧合指数(OI)的相关性及其对机械通气患者预后评估的价值.方法 选择南通大学第二附属医院急诊医学科行机械通气的危重症患者66例,其中男性45例,女性21例;年龄35～95岁,平均年龄72.11岁;病程2～37 d,平均病程12.03 d;疾病类型:肺炎、感染性休克等感染相关19例,心力衰竭16例,慢性阻塞性肺疾病急性发作呼吸衰竭15例,心肺复苏后11例,间质性肺炎2例,中毒2例,外伤1例.根据患者的转归情况(28 d生存或死亡)分为好转组28例与死亡组38例.分别使用改良BLUE方案、4分区、6分区、8分区及12分区评分方法对患者进行肺部超声检查,以12分区评分为对照,分别比较改良BLUE方案、4分区、6分区、8分区超声评分与12分区评分结果的相关性.记录各检查方案检查时间,比较各评分法耗时差异.分析改良BLUE方案与SOFA评分和O1的相关性.比较两组改良BLUE方案肺超声评分差异.结果 在机械通气患者中,改良BLUE方案、4分区、6分区、8分区超声评分结果,均与12分区法评分结果呈正相关(r=0.98、0.94、0.96、0.95,P均＜0.05),其中改良BLUE方案肺超声评分与12分区评分相关性最高.改良BLUE方案、4分区、6分区、8分区及12分区肺超声检查操作时间分别为(5.86±0.76)min、(4.86±0.71)min、(6.79±0.88)min、(8.18±1.02)min、(11.79±1.45)min,改良 BLUE 方案较 6 分区、8 分区及 12 分区操作时间短(P均＜0.05).改良BLUE方案肺超声评分与O1呈负相关,与SOFA评分呈正相关(r=-0.42、0.25).好转组与死亡组改良BLUE方案肺超声评分平均值分别为(12.04±5.87)分、(15.79±5.94)分.好转组改良BLUE方案肺超声评分明显低于死亡组,差异有统计学意义(P＜0.05).结论 在机械通气危重症患者中,使用改良BLUE方案肺超声评分具有准确度高、耗时短的优势,更适宜在急诊环境中对机械通气危重症患者进行快速病情评估.改良BLUE方案肺超声评分对机械通气患者病情严重程度及预后有一定指导价值.
Abstract
Objective To compare the application of modified BLUE scheme lung ultrasound score and traditional regional score in patient with mechanical ventilation,and probe the correlation between modified BLUE scheme and sequential organ failure assessment(SOFA)score,oxygenation index(OI)and its prognostic value in patient with mechanical ventilation.Meth-ods A total of 66 critically ill patients performed mechanical ventilation were enrolled,which included 45 males and 21 females,aged 35-95 years old with mean age of 72.11 years old;disease duration 2-37 days with mean duration of 12.03 days.There were 19 cases of pneumonia and septic shock infection,16 of heart failure,15 of acute respiratory fail-ure of chronic obstructive pulmonary disease,11 of complete cardiopulmonary resuscitation,2 of interstitial pneumonia,2 of poisoning and 1 of trauma.According to patient outcome(28-day survival or death),all of them were divided into improve-ment group(n=28)and death group(n=38).The modified BLUE scheme,4-zone,6-zone,8-zone and 12-zone scor-ing methods were used to perform lung ultrasound examination.The 12-zone score was used as control,and correlation with ultrasound scores of modified BLUE scheme,4-zone,6-zone,8-zone and 12-zone scoring methods was compared.The examination time of each scheme was recorded,and the time-consuming differences of each scoring method were com-pared.The correlation between modified BLUE scheme and SOFA score and O1 was analyzed.The difference of lung ultra-sound score between 2 groups was compared.Results In patient with mechanical ventilation,the ultrasound scores of modi-fied BLUE scheme,4-zone,6-zone and 8-zone were all positively correlated with results of 12-zone method(r=0.98,0.94,0.96,0.95,P＜0.05),and the correlation between modified BLUE scheme and 12-zone score was the highest.The lung ultra-sound examination time of modified BLUE scheme,4-zone,6-zone,8-zone and 12-zone were(5.86±0.76)minutes,(4.86±0.71)minutes,(6.79±0.88)minutes,(8.18±1.02)minutes and(11.79±1.45)minutes,respectively.The examination time of modified BLUE scheme was significantly shorter than that of 6-zone,8-zone and 12-zone(P＜0.05).The lung ultrasound score of modified BLUE scheme was negatively correlated with OI and positively correlated with SOFA score(r=-0.42,0.25).The mean lung ultrasound scores of improvement group and death group were(12.04±5.87)scores and(15.79±5.94)scores,respectively.The lung ultrasound score of modified BLUE scheme in improvement group was statistically significantly lower than that in death group(P＜0.05).Conclusion It is demonstrated that the application of modified BLUE scheme lung ultrasound score in critically ill patient with mechanical ventilation showed the advantages of high accuracy and short time,which is more suitable for rapid disease assessment in critically ill patient with emergency mechanical ventilation,and modified BLUE scheme lung ultrasound score has guiding value for the severity and prognosis of patient with mechanical ventilation.
基金项目
南通市科技局重点项目(HS2018002)
南通市科技局社会民生科技公众健康重点项目(MS22020010)
南通市卫生健康委项目(QA2021017)
NETL
NSTL
万方数据