肺超声探查术后低氧血症患者肺部并发症的可行性和疗效：一项前瞻性研究。
Feasibility and efficacy of lung ultrasound to investigate pulmonary complications in patients who developed postoperative Hypoxaemia-a prospective study.
机构信息
Department of Anesthesiology and Pain Medicine, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88th, Hangzhou, 310016, People's Republic of China.
Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY, 40202, USA.
出版信息
BMC Anesthesiol. 2020 Sep 1;20(1):220. doi: 10.1186/s12871-020-01123-6.
BACKGROUND
Postoperative pulmonary complications (PPCs) and hypoxaemia are associated with morbidity and mortality. We aimed to evaluate the feasibility and efficacy of lung ultrasound (LUS) to diagnose PPCs in patients suffering from hypoxaemia after general anaesthesia and compare the results to those of thoracic computed tomography (CT).
METHODS
Adult patients who received general anaesthesia and suffered from hypoxaemia in the postanaesthesia care unit (PACU) were analysed. Hypoxaemia was defined as an oxygen saturation measured by pulse oximetry (SPO) less than 92% for more than 30 s under ambient air conditions. LUS was performed by two trained anaesthesiologists once hypoxaemia occurred. After LUS examination, each patient was transported to the radiology department for thoracic CT scan within 1 h before returning to the ward.
RESULTS
From January 2019 to May 2019, 113 patients (61 men) undergoing abdominal surgery (45 patients, 39.8%), video-assisted thoracic surgery (31 patients, 27.4%), major orthopaedic surgery (17 patients, 15.0%), neurosurgery (10 patients, 8.8%) or other surgery (10 patients, 8.8%) were included. CT diagnosed 327 of 1356 lung zones as atelectasis, while LUS revealed atelectasis in 311 of the CT-confirmed zones. Pneumothorax was detected by CT scan in 75 quadrants, 72 of which were detected by LUS. Pleural effusion was diagnosed in 144 zones on CT scan, and LUS detected 131 of these zones. LUS was reliable in diagnosing atelectasis (sensitivity 98.0%, specificity 96.7% and diagnostic accuracy 97.2%), pneumothorax (sensitivity 90.0%, specificity 98.9% and diagnostic accuracy 96.7%) and pleural effusion (sensitivity 92.9%, specificity 96.0% and diagnostic accuracy 95.1%).
CONCLUSIONS
Lung ultrasound is feasible, efficient and accurate in diagnosing different aetiologies of postoperative hypoxia in healthy-weight patients in the PACU.
TRIAL REGISTRATION
Current Controlled Trials NCT03802175 , 2018/12/05, www.ClinicalTrials.gov.
背景
术后肺部并发症（PPCs）和低氧血症与发病率和死亡率有关。我们旨在评估肺部超声（LUS）在全麻后低氧血症患者中诊断 PPCs 的可行性和有效性，并将结果与胸部计算机断层扫描（CT）的结果进行比较。
方法
分析接受全身麻醉并在麻醉后恢复室（PACU）出现低氧血症的成年患者。低氧血症定义为脉搏血氧饱和度仪（SPO）测量的氧饱和度在环境空气条件下低于 92%超过 30 秒。一旦出现低氧血症，两名经过培训的麻醉师进行 LUS 检查。LUS 检查后，每位患者在返回病房前 1 小时内被送往放射科进行胸部 CT 扫描。
结果
2019 年 1 月至 2019 年 5 月，纳入了 113 名（61 名男性）接受腹部手术（45 名患者，39.8%）、电视辅助胸腔手术（31 名患者，27.4%）、大骨科手术（17 名患者，15.0%）、神经外科手术（10 名患者，8.8%）或其他手术（10 名患者，8.8%）的患者。CT 诊断了 1356 个肺区中的 327 个为肺不张，而 LUS 在 CT 确认的 311 个区域中发现了肺不张。CT 扫描发现 75 个象限的气胸，LUS 检测到 72 个。CT 扫描诊断胸腔积液 144 个区，LUS 检测到 131 个区。LUS 诊断肺不张的可靠性为（灵敏度 98.0%，特异性 96.7%和诊断准确性 97.2%）、气胸（灵敏度 90.0%，特异性 98.9%和诊断准确性 96.7%）和胸腔积液（灵敏度 92.9%，特异性 96.0%和诊断准确性 95.1%）。
结论
在 PACU 中，对于健康体重的患者，肺部超声在诊断术后低氧血症的不同病因方面是可行、有效和准确的。
试验注册
当前对照试验 NCT03802175 ，2018 年 12 月 5 日，www.ClinicalTrials.gov。
Zotero 插件