Wang J, Zhou H Y, Du Y, Cao F F, Zhang Y H, Zhang H T
Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 100035, China.
Zhonghua Yi Xue Za Zhi. 2020 Jan 21;100(3):220-224. doi: 10.3760/cma.j.issn.0376-2491.2020.03.012.
To investigate the value of bedside pulmonary ultrasound in the diagnosis and treatment of atelectasis in patients after cardiac surgery. A total of 45 patients developed respiratory failure within 1 week after cardiovascular surgery from April 2017 to April 2018 were enrolled in this study. Among them, 27 were male and 18 were female, mean age was (47±5) years. The postoperative pulmonary ultrasound and chest CT findings were collected, and the consistency, efficacy evaluation, timeliness and safety value of pulmonary ultrasound and chest CT diagnosis were compared. The consistency of the two diagnostic methods was checked based on the Kappa consistency test. A total of 87 foci of atelectasis were diagnosed in 45 patients, including 29 foci of complete atelectasis and 58 foci of incomplete atelectasis. Thoracic CT examination confirmed 44 cases of atelectasis (positive rate 97.8%), and 42 cases (93.3%) were found with atelectasis with ultrasound test. The two methods were consistent in the diagnosis of atelectasis (Kappa value was 0.741, 0.05). In the evaluation of the atelectasis, the results of the two examination methods were completely consistent, and the pulmonary ultrasound couldcheck the lung recruitment in real time. Ultrasound examination after lung recruitment showed that the total ventilation score of 42 patients decreased significantly when compared with that before treatment ((18.3±3.6) vs (26.6±3.8), 10.229, 0.05). There was no significant difference in the safety between the two examination methods. The time the bedside pulmonary ultrasound used was significantly shorter than that in the chest CT. The accuracy of bedside pulmonary ultrasound in assessing atelectasis after cardiovascular surgery is consistent with chest CT, it brings dynamic monitoring of lung status and assessment of lung recruitment by changes in lung ventilation scores. The inspection takes a short time and is worth promoting.
探讨床边肺部超声在心脏手术后肺不张诊断及治疗中的价值。选取2017年4月至2018年4月心血管手术后1周内发生呼吸衰竭的45例患者纳入本研究。其中,男性27例,女性18例,平均年龄(47±5)岁。收集术后肺部超声及胸部CT检查结果,比较肺部超声与胸部CT诊断的一致性、疗效评估、及时性及安全性价值。采用Kappa一致性检验检查两种诊断方法的一致性。45例患者共诊断出87个肺不张病灶,其中完全性肺不张病灶29个,不完全性肺不张病灶58个。胸部CT检查确诊肺不张44例(阳性率97.8%),超声检查发现42例(93.3%)有肺不张。两种方法在肺不张诊断上具有一致性(Kappa值为0.741,0.05)。在肺不张评估方面,两种检查方法结果完全一致,且肺部超声可实时观察肺复张情况。肺复张后超声检查显示,42例患者治疗后总通气评分较治疗前显著降低((18.3±3.6)vs(26.6±3.8),10.229,0.05)。两种检查方法安全性无显著差异。床边肺部超声检查用时明显短于胸部CT。床边肺部超声评估心血管术后肺不张的准确性与胸部CT一致,可通过肺通气评分变化实现对肺状态的动态监测及肺复张评估。检查用时短,值得推广。