| 摘要: |
| 目的探讨不同肺部超声（LUS）征象诊断呼吸机相关性肺炎（VAP）的价值。方法对124例临床疑诊为VAP患者分别进行LUS和胸部CT检查，并根据胸部CT和气道分泌物细菌半定量培养，分为VAP组和非VAP组。记录所有患者的体温、WBC、超敏C反应蛋白（hs-CRP）、氧合指数（PaO2/FiO2）、临床肺部感染评分（CPIS）及肺部超声检查结果。结果VAP组48例，非VAP组76例。VAP组有4例患者LUS检查阴性，44例患者LUS检查阳性，其中29例出现胸膜下小片实变，20例出现大片肺实变，7例出现静态支气管充气征，24例出现动态支气管充气征。非VAP组有48例患者LUS检查阴性，28例患者LUS检查阳性，其中18例出现胸膜下小片实变，13例出现大片肺实变，6例出现静态支气管充气征，1例出现动态支气管充气征。动态支气管充气征诊断VAP的灵敏度和特异度分别为50%（95%CI：35%～65%）和99%（95%CI：92%～100%）；LUS肺实变征象（胸膜下小片实变或大片肺实变）诊断VAP的灵敏度和特异度分别为92%（95%CI：79%～97%）和63%（95%CI：51%～74%）。结论对于存在症状和体征的可疑VAP患者，实变肺组织内出现动态支气管充气征是诊断VAP的特异性LUS征象。LUS是一种协助诊断VAP的有用的影像学工具。 |
| 关键词: 呼吸机相关性肺炎 肺部超声 动态支气管充气征 |
| DOI：10.12056/j.issn.1006-2785.2017.39.22.2017-376 |
| 分类号: |
| 基金项目:国家卫生计生委科学研究基金-浙江省医药卫生重大科技计划项目（WKJ-ZJ-1601）；浙江省医药卫生科研基金项目（2017KY182）；卫生厅骨干人才项目（2016RCB001） |
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| Value of lung ultrasound signs in diagnosis of ventilator-associated pneumonia |
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Taizhou Municipal hospital
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| Abstract: |
| Objective To assess the value of lung ultrasound (LUS) signs in the diagnosis of ventilator-associated pneu- monia (VAP). Methods The clinical data and imaging findings of 124 patients with suspected VAP admitted in ICU of Zhejiang Hospital and Taizhou Municipal Hospital from April 2015 to October 2016 were reviewed. Patients underwent LUS and chest CT examination, according to the results of chest CT and semi-quantitative culture of airway secretions, patients were divided into VAP group and non-VAP group. The body temperature, white blood cell count (WBC), hypersensitive C-reactive protein (hs-CRP), oxygenation index(PaO2/FiO2), clinical lung infection score(CPIS) and the results of LUS were recorded in all patients. Results There were 48 patients in VAP group and 76 in non-VAP group. Four patients in the VAP group had negative LUS find- ings and 44 patients had positive LUS findings, in which small subpleural consolidation was presented in 29 cases, lobar/hemilo- bar consolidation in 20 cases, static air bronchograms in 7 cases and dynamic air bronchograms in 24 cases. Forty eight patients in the non-VAP group had negative LUS findings and 28 patients had positive LUS findings, in which small subpleural consolida- tion was shown in 18 cases, lobar/hemilobar consolidation in 13 cases, static air bronchograms in 6 cases and dynamic air bron- chograms in 1 cases. The sensitivity and specificity of dynamic air bronchograms for the diagnosis of VAP were 50%(95%CI: 35%
-65%) and 99% (95%CI: 92%-100%), respectively, the sensitivity and specificity of pulmonary consolidation (small subpleural consolidation and lobar/hemilobar consolidation) were 92% (95% CI:79% -97% ) and 63% (95% CI:51% -74% ), respectively. Conclusion In patients with suspected VAP, presence of dynamic air bronchogram inside the consolidation is a specific LUS sign for the diagnosis of VAP. |
| Key words: Ventilator-associated pneumonia Lung uitrasound Static air bronchograms |
