即时肺部超声在 COVID-19 中的应用：105 例连续患者的发现与预后意义。
Point-of-Care Lung Ultrasound for COVID-19: Findings and Prognostic Implications From 105 Consecutive Patients.
机构信息
Division of Hospital Medicine, Department of Medicine, 8405MedStar Washington Hospital Center, Washington, DC, USA.
Division of Pulmonary, Critical Care, and Sleep Medicine, Care New England Medical Group, Pawtucket, RI, USA.
出版信息
J Intensive Care Med. 2021 Mar;36(3):334-342. doi: 10.1177/0885066620988831.
BACKGROUND
The prognostic value of point-of-care lung ultrasound has not been evaluated in a large cohort of patients with COVID-19 admitted to general medicine ward in the United States. The aim of this study was to describe lung ultrasound findings and their prognostic value in patients with COVID-19 admitted to internal medicine ward.
METHOD
This prospective observational study consecutively enrolled 105 hospitalized participants with COVID-19 at 2 tertiary care centers. Ultrasound was performed in 12 lung zones within 24 hours of admission. Findings were assessed relative to 4 outcomes: intensive care unit (ICU) need, need for intensive respiratory support, length of stay, and death.
RESULTS
We detected abnormalities in 92% (97/105) of participants. The common findings were confluent B-lines (92%), non-homogenous pleural lines (78%), and consolidations (54%). Large confluent B-lines, consolidations, bilateral involvement, and any abnormality in ≥ 6 areas were associated with a longer hospitalization and need for intensive respiratory support. Large confluent B-lines and bilateral involvement were also associated with ICU stay. A total lung ultrasound score <5 had a negative predictive value of 100% for the need of intensive respiratory support. A higher total lung ultrasound score was associated with ICU need (median total 18 in the ICU group vs. 11 non-ICU, p = 0.004), a hospitalization ≥ 9d (15 vs 10, p = 0.016) and need for intensive respiratory support (18 vs. 8.5, P < 0.001).
CONCLUSIONS
Most patients hospitalized with COVID-19 had lung ultrasound abnormalities on admission and a higher lung ultrasound score was associated with worse clinical outcomes except death. A low total lung ultrasound score (<5) had a negative predictive value of 100% for the need of intensive respiratory support. Point-of-care ultrasound can aid in the risk stratification for patients with COVID-19 admitted to general wards.
背景
在以美国综合医学病房收治的大量 COVID-19 患者中，尚未评估即时护理肺部超声的预后价值。本研究旨在描述综合医学病房收治的 COVID-19 患者的肺部超声表现及其预后价值。
方法
本前瞻性观察性研究连续纳入了 2 家三级保健中心的 105 名住院 COVID-19 患者。在入院后 24 小时内对 12 个肺区进行了超声检查。对 4 个结果进行了超声表现评估：入住重症监护病房（ICU）、需要强化呼吸支持、住院时间和死亡。
结果
我们在 92%（97/105）的患者中发现了异常。常见的表现为融合 B 线（92%）、非均匀胸膜线（78%）和实变（54%）。大融合 B 线、双侧受累以及≥6 个区域的任何异常与住院时间延长和需要强化呼吸支持相关。大融合 B 线和双侧受累也与入住 ICU 相关。总肺部超声评分<5 对需要强化呼吸支持具有 100%的阴性预测值。总肺部超声评分较高与入住 ICU 相关（ICU 组中位数为 18 分，非 ICU 组为 11 分，p=0.004）、住院时间≥9d（15 分与 10 分，p=0.016）和需要强化呼吸支持（18 分与 8.5 分，P<0.001）相关。
结论
大多数因 COVID-19 住院的患者在入院时存在肺部超声异常，较高的肺部超声评分与临床结局恶化相关，除死亡外。总肺部超声评分低（<5）对需要强化呼吸支持的阴性预测值为 100%。即时护理超声可帮助对收入普通病房的 COVID-19 患者进行风险分层。
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