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重症监护病房患者中超声床边定量胸腔积液与计算机断层扫描容积测定法的比较

Sonographic Bedside Quantification of Pleural Effusion Compared to Computed Tomography Volumetry in ICU Patients.

作者信息

Teichgräber Ulf Karl-Martin, Hackbarth Judith

机构信息

Institut für Diagnostische und Interventionelle Radiologie, Universtätsklinikum Jena, Jena, Germany.

Institut für Diagnostische und Interventionelle Radiologie, Charité Universitätsmedizin Berlin, Berlin, Germany.

出版信息

Ultrasound Int Open. 2018 Oct;4(4):E131-E135. doi: 10.1055/a-0747-6416. Epub 2018 Oct 26.

Abstract

OBJECTIVES

To date, the reliability of ultrasound for the quantitative assessment of pleural effusion has been limited. In the following study, an easy and cost-effective bedside ultrasound method was developed and investigated for specific use in the intensive care unit (ICU).

METHODS

22 patients (median age: 58.5 years, range: 37-88 years, 14 men and 8 women) with a total of 31 pleural effusions were examined in the ICU. The inclusion criterion was complete visualization of the effusion on chest computed tomography (CT). The ultrasound (US) examination was performed less than 6 h after the diagnostic CT scan. The pleural effusion volume was calculated volumetrically from the CT scan data. Within 4.58 +/- 2.87 h after the CT scan, all patients were re-examined with US in the ICU. The fluid crescent's thickness was measured between each intercostal space (ICS) with the patient in a supine position and a 30° inclination of the torso. The US measurements were compared to the calculated CT volumes using regression analysis, resulting in the following formula: V=13.330 x ICS6 (V=volume of the effusion [ml]; ICS6=sonographic measurement of the thickness of the liquid crescent [mm] in the sixth ICS).

RESULTS

A significant correlation between the sonographically measured and the CT-calculated volumes was best observed for the sixth ICS (R2=0.589; ICC=0.7469 with p<0.0001 and a 95% CI of 0.5364-0.8705).

CONCLUSION

The sonographic assessment of pleural effusions in a supine position and a 30° inclination of the torso is feasible for the volumetric estimation of pleural effusion. This is especially true for ICU patients with severe primary diseases and orthopnea who are unable to sit upright or lie flat.

摘要

目的

迄今为止,超声对胸腔积液进行定量评估的可靠性一直有限。在以下研究中,开发并研究了一种简便且经济高效的床旁超声方法,用于重症监护病房(ICU)的特定用途。

方法

在ICU对22例患者(中位年龄:58.5岁,范围:37 - 88岁,14例男性和8例女性)共31处胸腔积液进行了检查。纳入标准是胸部计算机断层扫描(CT)上积液完全可视化。超声(US)检查在诊断性CT扫描后不到6小时进行。胸腔积液体积通过CT扫描数据进行容积计算。在CT扫描后4.58±2.87小时内,所有患者在ICU再次接受超声检查。患者仰卧位且躯干倾斜30°时,测量每个肋间间隙(ICS)之间液性新月的厚度。使用回归分析将超声测量结果与计算出的CT体积进行比较,得出以下公式:V = 13.330×ICS6(V = 积液体积[ml];ICS6 = 第六肋间间隙中液性新月厚度的超声测量值[mm])。

结果

第六肋间间隙的超声测量体积与CT计算体积之间存在显著相关性,相关性最佳(R2 = 0.589;ICC = 0.7469,p < 0.0001,95% CI为0.5364 - 0.8705)。

结论

对于胸腔积液的容积估计,在仰卧位且躯干倾斜30°时进行超声评估是可行的。对于患有严重原发性疾病且有端坐呼吸、无法坐直或平躺的ICU患者尤其如此。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/67aa/6203686/af8700c76a19/10-1055-a-0747-6416-i0148-0001.jpg

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