肺部超声评估 COPD 急性加重患者肺部淤血。
Lung Ultrasound to Assess Pulmonary Congestion in Patients with Acute Exacerbation of COPD.
机构信息
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Department of Cardiology, Akershus University Hospital, Lørenskog, Norway.
出版信息
Int J Chron Obstruct Pulmon Dis. 2023 Apr 25;18:693-703. doi: 10.2147/COPD.S396855. eCollection 2023.
PURPOSE
Heart failure (HF) often coexists with chronic obstructive pulmonary disease (COPD) and is associated with worse outcomes. We aimed to assess the feasibility of detecting vertical artifacts (B-lines) on lung ultrasound (LUS) to identify concurrent HF in patients hospitalized with acute exacerbation of COPD (AECOPD). Second, we wanted to assess the association between B-lines and the risk of rehospitalization for AECOPD or death.
PATIENTS AND METHODS
In a prospective cohort study, 123 patients with AECOPD underwent 8-zone bedside LUS within 24h after admission. A positive LUS was defined by ≥3 B-lines in ≥2 zones bilaterally. The ability to detect concurrent HF (adjudicated by a cardiologist committee) and association with events were evaluated by logistic- and Cox regression models.
RESULTS
Forty-eight of 123 patients with AECOPD (age 75±9 years, 57[46%] men) had concurrent HF. Sixteen (13%) patients had positive LUS, and the prevalence of positive LUS was similar between patients with and without concurrent HF (8[17%] vs 8[11%], respectively, p=0.34). The number of B-lines was higher in concurrent HF: median 10(IQR 6-16) vs 7(IQR 5-12), p=0.03. The sensitivity and specificity for a positive LUS to detect concurrent HF were 17% and 89%, respectively. Positive LUS was not associated with rehospitalization and mortality: Adjusted HR: 0.93(0.49-1.75), p=0.81.
CONCLUSION
LUS did not detect concurrent HF or predict risk in patients with AECOPD.
目的
心力衰竭（HF）常与慢性阻塞性肺疾病（COPD）共存，并与更差的结局相关。我们旨在评估在因 COPD 急性加重（AECOPD）住院的患者中，通过检测肺部超声（LUS）中的垂直伪影（B 线）来识别同时存在 HF 的可行性。其次，我们希望评估 B 线与 AECOPD 再住院或死亡风险之间的关系。
患者和方法
在一项前瞻性队列研究中，123 例 AECOPD 患者在入院后 24 小时内接受了 8 区床边 LUS。双侧≥2 区出现≥3 条 B 线定义为阳性 LUS。通过逻辑回归和 Cox 回归模型评估检测同时存在 HF（由心脏病专家委员会裁决）的能力以及与事件的关联。
结果
123 例 AECOPD 患者中有 48 例（年龄 75±9 岁，57[46%] 名男性）同时患有 HF。16 例（13%）患者的 LUS 阳性，同时患有 HF 和无 HF 的患者中 LUS 阳性的发生率相似（分别为 8[17%]和 8[11%]，p=0.34）。同时存在 HF 的患者的 B 线数量较高：中位数 10（IQR 6-16）比 7（IQR 5-12），p=0.03。LUS 阳性检测同时存在 HF 的敏感性和特异性分别为 17%和 89%。LUS 阳性与再住院和死亡率无关：调整后的 HR：0.93（0.49-1.75），p=0.81。
结论
LUS 不能检测 AECOPD 患者同时存在的 HF 或预测风险。
Zotero 插件