Department of Emergency and Critical Care, Shanghai General Hospital of Shanghai Jiaotong University, Shanghai, China.
Department of Respiratory and Critical Care, Shanghai General Hospital of Shanghai Jiaotong University, Shanghai, China.
Ultrasound Med Biol. 2020 Nov;46(11):2938-2944. doi: 10.1016/j.ultrasmedbio.2020.07.024. Epub 2020 Jul 24.
The purpose of this study is to observe the potential of lung ultrasound in evaluating the severity of coronavirus disease 2019 (COVID-19) pneumonia. Lung ultrasound was performed in ten zones of the patients' chest walls. The features of the ultrasound images were observed, and a lung ultrasound score (LUS) was recorded. The ultrasound features and scores were compared between the refractory group (PaO/FiO ≤ 100 mm Hg or on extracorporeal membrane oxygenation) and the non-refractory group. The prediction value of the LUS was studied by receiver operating characteristic (ROC) curve analysis. In total, 7 patients were enrolled in the refractory group and 28 in the non-refractory group. B-line patterns and shred signs were the most common signs in all patients. Patients in the refractory group had significantly more ground-glass signs (median 6 [interquartile range {IQR}, 2.5-6.5] vs. median 0 [IQR, 0-3]), consolidation signs (median 1 [IQR, 1-1.5] vs. median 0 [IQR, 0-3]) and pleural effusions (median 5 [IQR, 1.5-6] vs. median 0 [IQR, 0-0.25]). The LUS was significantly higher in the refractory group (33.00 [IQR 27.50-34.00] vs. 25.50 [IQR 22.75-30.00]). The ROC of the LUS showed a cutoff score of 32 with a specificity of 0.893 and a sensitivity of 0.571 in diagnosing refractory respiratory failure among patients. In COVID-19 patients, lung ultrasound is a promising diagnostic tool in diagnosing patients with refractory pneumonia.
本研究旨在观察肺部超声在评估 2019 年冠状病毒病（COVID-19）肺炎严重程度中的作用。对患者胸壁的十个区域进行了肺部超声检查。观察超声图像的特征，并记录肺部超声评分（LUS）。比较难治性组（PaO/FiO ≤ 100mmHg 或体外膜氧合）和非难治性组的超声特征和评分。通过接收者操作特性（ROC）曲线分析研究 LUS 的预测价值。共有 7 例患者纳入难治性组，28 例患者纳入非难治性组。所有患者最常见的征象是 B 线模式和碎片征。难治性组患者的磨玻璃征（中位数 6[四分位距 {IQR}，2.5-6.5]比中位数 0[IQR，0-3]）、实变征（中位数 1[IQR，1-1.5]比中位数 0[IQR，0-3]）和胸腔积液（中位数 5[IQR，1.5-6]比中位数 0[IQR，0-0.25]）明显更多。难治性组的 LUS 明显更高（33.00[IQR 27.50-34.00]比 25.50[IQR 22.75-30.00]）。LUS 的 ROC 显示，在诊断 COVID-19 患者难治性呼吸衰竭时，截断值为 32，特异性为 0.893，敏感性为 0.571。在 COVID-19 患者中，肺部超声是一种很有前途的诊断工具，可用于诊断难治性肺炎患者。
