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目的探索肺超声评分(LUS)判定血管外肺水指数(EVLW)的敏感度和特异度。方法入选2012年6月至2014年12月首都医科大学附属复兴医院重症医学科连续收治的急性呼吸窘迫综合征(ARDS)患者21例,于入ICU第1个24 h内记录患者一般临床特征,完善胸部CT检查,并于入ICU第1、2、3天分别行床旁X线胸片、肺超声及判定与脉搏指示持续心排量监测(PiCCO)3者检查时间相隔<2 h;同时设立非ARDS患者为对照组,于24h内完成肺超声、胸部CT及胸片检查。结果 LUS与PiCCO测定的EVLWI呈显著线性相关(r=0.927,P<0.01);LUS与X线胸片评分之间呈显著正相关(r=0.720,P<0.01)。肺超声判定ELVW的ROC曲线下面积为0.924(P<0.01),cut-off值为12.5,其敏感度和特异度分别为0.857和0.600;床旁X线胸片判定ELVW的ROC曲线下面积为0.732(P=0.019),cut-off值为14.0,其敏感度和特异度分别为0.619和0.667。结论 LUS具有较高的敏感度和特异度及可重复性用以定性及定量判定ARDS患者EVLW。
Objective To explore the sensitivity and specificity of lung ultrasound score (LUS) in determining extravascular lung water index (EVLW). Methods Twenty-one acute respiratory distress syndrome (ARDS) patients admitted to Fuxing Hospital Affiliated to Capital University of Medical Sciences from June 2012 to December 2014 were enrolled in this study. The general clinical features, Perfect chest CT examination, and in the first day 1,2,3, respectively, into the bedside X-ray, pulmonary ultrasound and determination and continuous cardiac output monitoring of pulse rate (PiCCO) 3 were separated from the time <2h; at the same time Patients with non-ARDS were set as control group, and pulmonary echocardiography, chest CT and chest radiography were performed within 24 hours. Results There was a significant linear correlation between LUS and PiCCO EVLWI (r = 0.927, P <0.01). There was a significant positive correlation between LUS and X-ray score (r = 0.720, P <0.01). The area under the ROC curve of ELVW was 0.924 (P <0.01), and the cut-off value was 12.5 with the sensitivity and specificity of 0.857 and 0.600, respectively. The area under the bedside X-ray showed that the area under the ROC curve of ELVW was 0.732 (P = 0.019). The cut-off value was 14.0. The sensitivity and specificity were 0.619 and 0.667, respectively. Conclusion LUS has high sensitivity and specificity and repeatability for the qualitative and quantitative determination of EVDS in patients with ARDS.