Martindale Jennifer L, Secko Michael, Kilpatrick John F, deSouza Ian S, Paladino Lorenzo, Aherne Andrew, Mehta Ninfa, Conigiliaro Alyssa, Sinert Richard
State University of New York Downstate Medical Center, Brooklyn, New York, USA.
Stony Brook University Hospital, Stony Brook, New York, USA.
J Ultrasound Med. 2018 Feb;37(2):337-345. doi: 10.1002/jum.14336. Epub 2017 Jul 31.
Objective measures of clinical improvement in patients with acute heart failure (AHF) are lacking. The aim of this study was to determine whether repeated lung sonography could semiquantitatively capture changes in pulmonary edema (B-lines) in patients with hypertensive AHF early in the course of treatment.
We conducted a feasibility study in a cohort of adults with acute onset of dyspnea, severe hypertension in the field or at triage (systolic blood pressure ≥ 180 mm Hg), and a presumptive diagnosis of AHF. Patients underwent repeated dyspnea and lung sonographic assessments using a 10-cm visual analog scale (VAS) and an 8-zone scanning protocol. Lung sonographic assessments were performed at the time of triage, initial VAS improvement, and disposition from the emergency department. Sonographic pulmonary edema was independently scored offline in a randomized and blinded fashion by using a scoring method that accounted for both the sum of discrete B-lines and degree of B-line fusion.
Sonographic pulmonary edema scores decreased significantly from initial to final sonographic assessments (P < .001). The median percentage decrease among the 20 included patient encounters was 81% (interquartile range, 55%-91%). Although sonographic pulmonary edema scores correlated with VAS scores (ρ = 0.64; P < .001), the magnitude of the change in these scores did not correlate with each other (ρ = -0.04; P = .89).
Changes in sonographic pulmonary edema can be semiquantitatively measured by serial 8-zone lung sonography using a scoring method that accounts for B-line fusion. Sonographic pulmonary edema improves in patients with hypertensive AHF during the initial hours of treatment.
急性心力衰竭（AHF）患者临床改善的客观指标尚缺乏。本研究旨在确定重复肺部超声检查能否在治疗早期半定量地捕捉高血压性AHF患者肺水肿（B线）的变化。
我们对一组急性起病的呼吸困难、现场或分诊时严重高血压（收缩压≥180mmHg）且初步诊断为AHF的成年人进行了一项可行性研究。患者使用10厘米视觉模拟量表（VAS）和8区扫描方案接受重复的呼吸困难和肺部超声评估。在分诊时、VAS首次改善时以及从急诊科出院时进行肺部超声评估。超声肺水肿由一名独立的离线人员以随机和盲法使用一种计分方法进行评分，该方法同时考虑了离散B线的总和以及B线融合程度。
从首次到最后一次超声评估，超声肺水肿评分显著降低（P<0.001）。20例纳入的患者就诊中，中位数下降百分比为81%（四分位间距，55%-91%）。虽然超声肺水肿评分与VAS评分相关（ρ=0.64；P<0.001），但这些评分变化的幅度彼此不相关（ρ=-0.04；P=0.89）。
超声肺水肿的变化可以通过使用考虑B线融合的计分方法的连续8区肺部超声半定量测量。高血压性AHF患者在治疗的最初几个小时内超声肺水肿有所改善。
