肺部超声评分在新型冠状病毒肺炎并发ARDS患者中的应用

Application of lung ultrasound score in patients with coronavirus disease 2019 complicated with acute respiratory distress syndrome

摘要:

目的：探讨肺部超声评分在新型冠状病毒肺炎（coronavirus disease 2019，COVID-19）并发急性呼吸窘迫综合征（acute respiratory distress syndrome，ARDS）患者中的应用方法和价值。方法：选取武汉市第一医院18例COVID-19并发ARDS患者为研究对象，采用前瞻性双盲对照研究，记录患者临床资料，行胸部CT检查、肺部超声检查及评分，以胸部CT为“金标准”，评价超声对肺不张/实变的诊断价值，并采用Pearson相关性检验比较肺部超声评分与氧合指数、COVID-19并发ARDS的诊断相关性，ROC曲线评价肺部超声评分预测COVID-19并发ARDS的敏感性及特异性。结果：纳入COVID-19并发ARDS患者18例，共进行38次肺部超声评分及胸部CT检查，检查了456个肺区，CT诊断肺不张/实变185区，超声诊断肺不张/实变166区，超声诊断的敏感性、特异性、阳性预测值、阴性预测值及诊断正确率分别为83.9％、95.9％、93.4％、89.7％、91.0％。肺部超声评分与氧合指数有显著相关性（r=-0.812）。以肺部超声评分20.5分为界时，COVID-19并发重度ARDS的ROC曲线下面积为0.885，敏感度为76.9%，特异度为88.0%。结论：肺部超声简单易行，对COVID-19并发ARDS具有较高的诊断效能，肺部超声评分可以评估COVID-19并发ARDS的病情严重程度，值得在临床推广应用。

Abstract:

Objective：To explore the application and value of lung ultrasound score in patients with coronavirus disease 2019 （COVID-19） complicated with acute respiratory distress syndrome（ARDS）. Methods：A total of 18 patients with COVID-19 compli－cated with ARDS in a Wuhan hospital were selected. The prospective double-blind cohort study was performed and patients’ clinical data were recorded. Chest computed tomography（CT） and lung ultrasound were performed and CT was regarded as the “golden stan－dard” to evaluate the value of ultrasound in diagnose lung atelectasis/consolidation. Pearson correlation test was used to compare the correlation between lung ultrasound score and oxygenation index and COVID-19 complicated with ARDS. ROC curve was used to evaluate the threshold of lung ultrasound score to predict sensitivity and specificity of COVID-19 complicated with severe ARDS. Results：Among these 18 patients，a total of 38 times chest CT and lung ultrasound were performed and 456 lung regions were exam－ined，among which 185 were lung atelectasis/consolidation via CT，while 166 were atelectasis/consolidation via ultrasound. Sensitivity，specificity，positive predictive value，negative predictive value and diagnostic accuracy of lung ultrasound were 83.9%，95.9%，93.4%，89.7% and 91.0% respectively. The correlation coefficient between lung ultrasound score and oxygenation index was significantly cor－related（r=-0.812）. Taking lung ultrasound score of 20.5 as the threshold value，the area under ROC curve for COVID-19 complicated with ARDS was 0.885，the sensitivity was 76.9% and the specificity was 88.0%. Conclusion：Lung ultrasound is simple to perform and has a relatively high efficiency to COVID-19 complicated with ARDS. Lung ultrasound score can be used in assessing the severity of COVID-19 complicated with ARDS and is worthy of promotion.