重大心脏手术后的彩色多谱勒超声提高急性呼吸衰竭肺部感染评分的诊断准确性：一项前瞻性观察研究。

Colour Doppler ultrasound after major cardiac surgery improves diagnostic accuracy of the pulmonary infection score in acute respiratory failure: A prospective observational study.

出版信息

Eur J Anaesthesiol. 2019 Sep;36(9):676-682. doi: 10.1097/EJA.0000000000001022.

Abstract

BACKGROUND

Postoperative pneumonia is a frequent complication after cardiac surgery, and its diagnosis is difficult. Little is known about the diagnostic accuracy of lung ultrasound (LUS) in the detection of pneumonia in cardiac surgical patients. The substitution of chest radiography by colour Doppler LUS (LUS-sCPIS) in the simplified clinical pulmonary infection score (sCPIS) could improve the diagnosis of pneumonia following cardiac surgery.

OBJECTIVE

The aim of this study was to compare the diagnostic accuracy of LUS-sCPIS and of sCPIS alone in the detection of postoperative pneumonia after cardiac surgery.

DESIGN

A prospective study of diagnostic accuracy.

SETTING

A Surgical Intensive Care Unit of a French University Hospital.

PATIENTS

Fifty-one patients with acute respiratory failure within 72 h after cardiac surgery were enrolled between January and May 2015.

MAIN OUTCOME MEASURE

The two index tests, LUS-sCPIS and sCPIS, were calculated for all patients at the onset of acute respiratory failure. The reference standard for the diagnosis of pneumonia was based on the consensus of three physicians, blind to the sCPIS and LUS-sCPIS data, based on a posthoc review of all the clinical, radiological and microbiological evidence. The diagnostic accuracy of LUS-sCPIS was compared with that of sCPIS in the detection of postoperative pneumonia.

RESULTS

Pneumonia was diagnosed in 26 out of 51 patients. The LUS-sCPIS detected the presence of pneumonia with a sensitivity of 92% (95% CI 0.85 to 0.99) and a specificity of 68% (95% CI 0.55 to 0.81). The sCPIS detected the presence of pneumonia with a sensitivity of 35% (95% CI 0.22 to 0.48) and a specificity of 84% (95% CI 0.74 to 0.94). The area under the curve (AUC) of LUS-sCPIS at 0.80 (95% CI 0.69 to 0.91) was higher than the AUC of sCPIS at 0.59 (95% CI 0.47 to 0.71; P = 0.0008).

CONCLUSION

Compared with sCPIS, LUS-sCPIS improved diagnostic accuracy in the detection of postoperative pneumonia in patients with acute respiratory failure after cardiac surgery. It could be a useful bedside tool to guide pneumonia management.

TRIAL REGISTRATION

Clinicaltrials.gov identifier: NCT03279887.

摘要

背景

术后肺炎是心脏手术后常见的并发症，其诊断较为困难。对于心脏外科患者中肺炎的诊断，尚不清楚肺部超声（LUS）的诊断准确性如何。简化临床肺部感染评分（sCPIS）中用彩色多普勒 LUS（LUS-sCPIS）替代胸部 X 线摄影，可以提高心脏手术后肺炎的诊断。

目的

本研究旨在比较 LUS-sCPIS 和单独使用 sCPIS 检测心脏手术后急性呼吸衰竭患者术后肺炎的诊断准确性。

设计

一项诊断准确性的前瞻性研究。

设置

法国大学医院的外科重症监护病房。

患者

2015 年 1 月至 5 月期间，心脏手术后 72 小时内出现急性呼吸衰竭的 51 例患者入组。

主要观察指标

所有患者在急性呼吸衰竭发作时计算 LUS-sCPIS 和 sCPIS 两个指标。肺炎的参考标准基于三位医生的共识，他们根据所有临床、影像学和微生物学证据进行盲法评估后得出。比较 LUS-sCPIS 和 sCPIS 在检测术后肺炎中的诊断准确性。

结果

51 例患者中，26 例诊断为肺炎。LUS-sCPIS 检测到肺炎的灵敏度为 92%（95%CI 0.85 至 0.99），特异性为 68%（95%CI 0.55 至 0.81）。sCPIS 检测到肺炎的灵敏度为 35%（95%CI 0.22 至 0.48），特异性为 84%（95%CI 0.74 至 0.94）。LUS-sCPIS 的曲线下面积（AUC）为 0.80（95%CI 0.69 至 0.91），高于 sCPIS 的 AUC（0.59，95%CI 0.47 至 0.71；P=0.0008）。