严重 COVID-19 肺炎患者的间质肺混浊通过床边高分辨率超声与 CO2 潴留相关。

Interstitial lung opacities in patients with severe COVID-19 pneumonia by bedside high-resolution ultrasound in association to CO2 retention.

机构信息

Department of Gastroenterology, Endocrinology, Rheumatology and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany.

Department of Radiology, University Hospital Regensburg, Regensburg, Germany.

出版信息

Clin Hemorheol Microcirc. 2021;77(4):355-365. doi: 10.3233/CH-200925.

DOI:10.3233/CH-200925

PMID:33285628

Abstract

BACKGROUND

Coronavirus disease 2019 (COVID-19) can cause acute respiratory distress syndrome (ARDS).

OBJECTIVE

This single centre cross-section study aimed to grade the severity of pneumonia by bed-side lung ultrasound (LUS).

METHODS

A scoring system discriminates 5 levels of lung opacities: A-lines (0 points),≥3 B-line (1 point), coalescent B-lines (2 points), marked pleural disruptions (3 points), consolidations (4 points). LUS (convex 1-5 MHz probe) was performed at 6 defined regions for each hemithorax either in supine or prone position. A lung aeration score (LAS, maximum 4 points) was allocated for each patient by calculating the arithmetic mean of the examined lung areas. Score levels were correlated with ventilation parameters and laboratory markers.

RESULTS

LAS of 20 patients with ARDS reached from 2.58 to 3.83 and was highest in the lateral right lobe (Mean 3.67). Ferritin levels (Mean 1885μg/l; r = 0.467; p = 0.051) showed moderate correlation in spearman roh calculation. PaCO2 level (Mean 46.75 mmHg; r = 0.632; p = 0.005) correlated significantly with LAS, while duration of ventilation, Horovitz index, CRP, LDH and IL-6 did not.

CONCUSIONS

The proposed LAS describes severity of lung opacities in COVID-19 patients and correlates with CO2 retention in patients with ARDS.

摘要

背景

2019 年冠状病毒病（COVID-19）可引起急性呼吸窘迫综合征（ARDS）。

目的

本单中心横断面研究旨在通过床边肺部超声（LUS）对肺炎的严重程度进行分级。

方法

评分系统将肺不透明度分为 5 个等级：A 线（0 分）、≥3 条 B 线（1 分）、融合 B 线（2 分）、明显的胸膜破裂（3 分）、实变（4 分）。LUS（凸面 1-5MHz 探头）在仰卧或俯卧位下于每侧半胸的 6 个特定区域进行检查。通过计算检查肺区的算术平均值，为每位患者分配肺充气评分（LAS，最高 4 分）。评分等级与通气参数和实验室标志物相关。

结果

20 例 ARDS 患者的 LAS 从 2.58 到 3.83，右侧外侧叶最高（平均值为 3.67）。铁蛋白水平（平均值 1885μg/L；r=0.467；p=0.051）在 Spearman 相关分析中呈中度相关。PaCO2 水平（平均值 46.75mmHg；r=0.632；p=0.005）与 LAS 显著相关，而通气时间、Horovitz 指数、CRP、LDH 和 IL-6 则不相关。