床旁超声对急性心源性肺水肿患者病情程度及治疗预后的评估价值
Evaluation value of bedside ultrasound in severity and prognosis of patients with acute cardiogenic pulmonary edema
崔丽娟 1田鹏飞1
作者信息
- 1. 457000 河南省濮阳市人民医院超声科
- 折叠
摘要
目的 探讨床旁超声对急性心源性肺水肿患者病情程度及治疗预后的评估价值.方法 对2022年 10 月至 2023年 9 月于濮阳市人民医院进行无创通气治疗且进行床旁超声检查的 82 例急性心源性肺水肿患者的临床资料进行回顾性分析,将所患者分为治疗成功组和治疗失败组.采用Pearson相关性软件分析治疗前患者肺部超声评分和血浆脑钠肽(BNP)、动脉血氧分压(PaO2)的相关性,将治疗成功组和治疗失败组患者基线资料进行对比,对急性心源性肺水肿患者治疗失败的影响因素进行多因素Logistic回归分析,采用受试者工作特征(ROC)曲线分析床旁超声参数预测急性心源性肺水肿患者治疗失败的诊断效能.结果 Pearson相关性软件分析结果得出,治疗前患者肺部超声评分与血浆BNP呈正相关(r=0.60,P<0.05),而与PaO2 呈负相关(r=-0.73,P<0.05);治疗成功组患者二氧化碳分压/吸入氧分压(PaCO2/FiO2)、右心室侧壁收缩期峰值速度(Sm)、比治疗失败组高,血肌酐、肺部超声评分、二尖瓣E/e'、肺动脉收缩压、右心功能障碍患者占比相较于治疗失败组低,差异有统计学意义(均P<0.05),而2组患者性别、年龄、体温、心率、收缩压、舒张压、PaCO2、左心室射血分数指标对比,差异无统计学意义(均P＞0.05);多因素Logistic回归分析结果得出,肺部超声评分、二尖瓣E/e'、肺动脉收缩压为急性心源性肺水肿患者治疗失败的危险因素(OR=2.779、1.390、1.231,均P<0.05);ROC曲线结果得出,肺部超声评分、二尖瓣E/e'、肺动脉收缩压预测急性心源性肺水肿患者治疗失败的曲线下面积(AUC)值分别为 0.799、0.774、0.842.结论 床旁超声可作为辅助方式应用于对急性心源性肺水肿患者的诊断,床旁超声检查获取的肺部超声评分、二尖瓣E/e'、肺动脉收缩压可用于对急性心源性肺水肿患者病情程度及治疗预后进行评估,临床价值较高.
Abstract
Objective To investigate the value of bedside ultrasound in evaluating the severity and prognosis of acute cardiogenic pulmonary edema.Methods The clinical data of 82 patients with acute cardiogenic pulmonary edema who underwent noninvasive ventilation and bedside ultrasound examination in Puyang People's Hospital from October 2022 to September 2023 were retrospectively analyzed.The patients were divided into successful treatment group and failed treatment group.Pearson correlation software was used to analyze the correlation between pulmonary ultrasound scores,plasma brain natriuretic peptide(BNP)and partial arterial blood pressure(PaO2)of patients before treatment.The baseline data of patients in the successful treatment group and the failed treatment group were com-pared,and the influencing factors of treatment failure in patients with acute cardiogenic pulmonary edema were ana-lyzed by multivariate Logistic regression.Receiver operating characteristic(ROC)curve was used to analyze the diag-nostic efficacy of bedside ultrasound parameters in predicting treatment failure in patients with acute cardiogenic pul-monary edema.Results The results of pearson correlation software analysis showed that the pulmonary ultrasound scores were positively correlated with plasma BNP(r=0.60,P<0.05),but negatively correlated with PaO2(r=-0.73,P<0.05).Partial pressure of carbon dioxide/partial pressure of inhaled(PaCO2/FiO2)and peak systolic velocity(Sm)of the right ventricular wall in the successful treatment group were higher than those in the failed treatment group,and the proportion of creatinine,pulmonary ultrasound score,mitral valve E/e ',pulmonary artery systolic blood pressure and right heart dysfunction were lower than those in the failed treatment group(all P<0.05).There were no significant dif-ferences in gender,age,body temperature,heart rate,systolic blood pressure,diastolic blood pressure,PaCO2 and left ventricular ejection fraction between 2 groups(all P＞0.05).Multivariate Logistic regression analysis showed that pul-monary ultrasound score,mitral valve E/e'and pulmonary artery systolic blood pressure were risk factors for treatment failure in patients with acute cardiogenic pulmonary edema(OR=2.78,1.39,1.23,all P<0.05).ROC curve results showed that the area under the curve(AUC)values of pulmonary ultrasound score,mitral valve E/e' and pulmonary artery systolic pressure in predicting treatment failure in patients with acute cardiogenic pulmonary edema were 0.799,0.774 and 0.842,respectively.Conclusion Bedside ultrasound can be used as an auxiliary method in the diagnosis of patients with acute cardiogenic pulmonary edema.The pulmonary ultrasound score,mitral valve E/e'and pulmonary systolic blood pressure obtained by bedside ultrasound can be used to evaluate the severity and prognosis of patients with acute cardiogenic pulmonary edema,which has high clinical value.
关键词
超声检查/肺水肿/预后/病人病情程度/自我评估Key words
Ultrasonography/Pulmonary edema/Prognosis/Patient acuity/Self-assessment引用本文复制引用
出版年
2024
NETL
NSTL
维普
万方数据