床旁超声检查与脑钠肽在检测急性呼吸困难的心源性病因中的比较

Bedside Ultrasonography versus Brain Natriuretic Peptide in Detecting Cardiogenic Causes of Acute Dyspnea.

作者信息

Golshani Keihan, Esmailian Mehrdad, Valikhany Aniseh, Zamani Majid

机构信息

Emergency Department, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.

出版信息

Emerg (Tehran). 2016 Summer;4(3):140-4.

PMID:27299143

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4902208/

Abstract

INTRODUCTION

Acute dyspnea is a common cause of hospitalization in emergency departments (ED).Distinguishing the cardiac causes of acute dyspnea from pulmonary ones is a major challenge for responsible physicians in EDs. This study compares the characteristics of bedside ultrasonography with serum level of blood natriuretic peptide (BNP) in this regard.

METHODS

This diagnostic accuracy study compares bedside ultrasonography with serum BNP levels in differentiating cardiogenic causes of acute respiratory distress. Echocardiography was considered as the reference test. A checklist including demographic data (age and sex), vital signs, medical history, underlying diseases, serum level of BNP, as well as findings of chest radiography, chest ultrasonography, and echocardiography was filled for all patients with acute onset of dyspnea. Screening characteristics of the two studied methods were calculated and compared using SPSS software, version 20.

RESULTS

48 patients with acute respiratory distress were evaluated (50% female). The mean age of participants was 66.94 ± 16.33 (28-94) years. Based on the results of echocardiography and final diagnosis, the cause of dyspnea was cardiogenic in 20 (41.6%) cases. Bedside ultrasonography revealed the cardiogenic cause of acute dyspnea in 18 cases (0 false positive) and BNP in 44 cases (24 false positives). The area under the ROC curve for bedside ultrasonography and BNP for differentiating the cardiogenic cause of dyspnea were 86.4 (95% CI: 74.6-98.3) and 66.3 (95% CI: 49.8-89.2), respectively (p = 0.0021).

CONCLUSION

It seems that bedside ultrasonography could be considered as a helpful and accurate method in differentiating cardiogenic causes of acute dyspnea in emergency settings. Nevertheless, more study is needed to make a runaway algorithm to evaluate patients with respiratory distress using bedside ultrasonography, which leads to rapid therapeutic decisions in a short time.

摘要

引言

急性呼吸困难是急诊科住院的常见原因。区分急性呼吸困难的心脏原因和肺部原因是急诊科医生面临的一项重大挑战。本研究在这方面比较了床旁超声检查与血清脑钠肽（BNP）水平的特征。

方法

本诊断准确性研究比较了床旁超声检查与血清BNP水平在鉴别急性呼吸窘迫的心源性原因方面的差异。超声心动图被视为参考检查。为所有急性起病的呼吸困难患者填写了一份清单，包括人口统计学数据（年龄和性别）、生命体征、病史、基础疾病、血清BNP水平，以及胸部X线、胸部超声和超声心动图的检查结果。使用SPSS 20版软件计算并比较了两种研究方法的筛查特征。

结果

对48例急性呼吸窘迫患者进行了评估（50%为女性）。参与者的平均年龄为66.94±16.33（28 - 94）岁。根据超声心动图结果和最终诊断，20例（41.6%）患者的呼吸困难原因是心源性的。床旁超声检查发现18例急性呼吸困难的心源性原因（无假阳性），BNP检查发现44例（24例假阳性）。床旁超声检查和BNP鉴别呼吸困难心源性原因的ROC曲线下面积分别为86.4（95%CI：74.6 - 98.3）和66.3（95%CI：49.8 - 89.2）（p = 0.0021）。