Mumoli Nicola, Vitale Josè, Giorgi-Pierfranceschi Matteo, Cresci Alessandra, Cei Marco, Basile Valentina, Brondi Barbara, Russo Elisa, Giuntini Lucia, Masi Lorenzo, Cocciolo Massimo, Dentali Francesco
From the Department of Internal Medicine, Ospedale Civile di Livorno, Livorno (NM, AC, MC, VB, BB, ER, LG, LM, MC), Department of Internal Medicine, Ospedale di Circolo, Varese (JV, FD), and Emergency Department, Ospedale della Val d'Arda, Piacenza (MGP), Italy.
Medicine (Baltimore). 2016 Mar;95(9):e2925. doi: 10.1097/MD.0000000000002925.
In clinical practice lung ultrasound (LUS) is becoming an easy and reliable noninvasive tool for the evaluation of dyspnea. The aim of this study was to assess the accuracy of nurse-performed LUS, in particular, in the diagnosis of acute cardiogenic pulmonary congestion. We prospectively evaluated all the consecutive patients admitted for dyspnea in our Medicine Department between April and July 2014. At admission, serum brain natriuretic peptide (BNP) levels and LUS was performed by trained nurses blinded to clinical and laboratory data. The accuracy of nurse-performed LUS alone and combined with BNP for the diagnosis of acute cardiogenic dyspnea was calculated. Two hundred twenty-six patients (41.6% men, mean age 78.7 ± 12.7 years) were included in the study. Nurse-performed LUS alone had a sensitivity of 95.3% (95% CI: 92.6-98.1%), a specificity of 88.2% (95% CI: 84.0-92.4%), a positive predictive value of 87.9% (95% CI: 83.7-92.2%) and a negative predictive value of 95.5% (95% CI: 92.7-98.2%). The combination of nurse-performed LUS with BNP level (cut-off 400 pg/mL) resulted in a higher sensitivity (98.9%, 95% CI: 97.4-100%), negative predictive value (98.8%, 95% CI: 97.2-100%), and corresponding negative likelihood ratio (0.01, 95% CI: 0.0, 0.07). Nurse-performed LUS had a good accuracy in the diagnosis of acute cardiogenic dyspnea. Use of this technique in combination with BNP seems to be useful in ruling out cardiogenic dyspnea. Other studies are warranted to confirm our preliminary findings and to establish the role of this tool in other settings.
在临床实践中，肺部超声（LUS）正成为评估呼吸困难的一种简便且可靠的非侵入性工具。本研究的目的是评估护士操作的LUS在诊断急性心源性肺淤血方面的准确性。我们前瞻性地评估了2014年4月至7月间在我院内科因呼吸困难入院的所有连续患者。入院时，由对临床和实验室数据不知情的经过培训的护士进行血清脑钠肽（BNP）水平检测和LUS检查。计算了护士单独操作LUS以及联合BNP诊断急性心源性呼吸困难的准确性。226例患者（男性占41.6%，平均年龄78.7±12.7岁）纳入本研究。护士单独操作LUS的敏感性为95.3%（95%可信区间：92.6 - 98.1%），特异性为88.2%（95%可信区间：84.0 - 92.4%），阳性预测值为87.9%（95%可信区间：83.7 - 92.2%），阴性预测值为95.5%（95%可信区间：92.7 - 98.2%）。护士操作的LUS与BNP水平（临界值400 pg/mL）联合使用时，敏感性更高（98.9%，95%可信区间：97.4 - 100%），阴性预测值更高（98.8%，95%可信区间：97.2 - 100%），相应的阴性似然比为0.01（95%可信区间：0.0，0.07）。护士操作的LUS在诊断急性心源性呼吸困难方面具有良好的准确性。将该技术与BNP联合使用似乎有助于排除心源性呼吸困难。需要其他研究来证实我们的初步发现，并确定该工具在其他情况下的作用。
