Gu Dongming, Zhang Bo, Li Jing, Li Yanpeng, Wang Zhihua, Diao Jianjun
Department of Emergency, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, People's Republic of China.
J Multidiscip Healthc. 2023 Sep 13;16:2707-2714. doi: 10.2147/JMDH.S424667. eCollection 2023.
To investigate the early application of pulmonary ultrasonography and arterial blood gas analysis in critical patients with severe multiple injuries exacerbated by respiratory failure.
The retrospective selection was performed on 81 patients admitted to our critical care unit between January 2020 and January 2021 with severe multiple injuries rendered worse by respiratory failure. Based on the different examination procedures, the patients were categorised into three groups (n=27): group A; diagnosed with pulmonary ultrasonography, group B; diagnosed with arterial blood gas; and group C; diagnosed with both pulmonary ultrasonography and arterial blood gas analyses. Patients were subsequently divided into a survival group (n = 65) and a death group (n = 16). On an annual basis, patients' prognoses were examined in relation to the predictive value of pulmonary ultrasound.
Initial diagnosis, diagnosis, and initial correct treatment times were significantly shorter in groups B and C than group A (P<0.05). In contrast, initial diagnosis time, diagnosis time, and initial correct treatment times were potentially shorter in group C than in group B (P<0.05). Compared to groups B and C, group A had a considerably lower diagnosis rate for the examination methods (P<0.05). The right diaphragm displacement and left diaphragm displacement in the survival group were potentially higher than the LUS score (P < 0.05). In contrast, the survival group's lung ultrasound score (LUS) was considerably lower than the death group's. Statistical analysis showed that the predictive values of right diaphragm displacement, left diaphragm displacement, and mean diaphragm displacement were significant compared with the LUS score. The findings of the receiver operating characteristic curve demonstrated that the right, left, and average diaphragm displacements had high predictive values.
In the early evaluation of patients with severe multiple injuries complicated by respiratory failure, pulmonary ultrasonography combined with arterial blood gas analysis is crucial for the rapid diagnosis and prognosis prediction of patients.
探讨肺部超声检查和动脉血气分析在因呼吸衰竭而病情加重的严重多发伤重症患者中的早期应用。
回顾性选取2020年1月至2021年1月期间入住我院重症监护病房的81例因呼吸衰竭而病情加重的严重多发伤患者。根据不同的检查程序，将患者分为三组（n = 27）：A组；采用肺部超声检查进行诊断，B组；采用动脉血气分析进行诊断，C组；采用肺部超声检查和动脉血气分析进行诊断。随后将患者分为生存组（n = 65）和死亡组（n = 16）。每年对患者的预后与肺部超声的预测价值进行评估。
B组和C组的初始诊断时间、确诊时间和初始正确治疗时间均显著短于A组（P < 0.05）。相比之下，C组的初始诊断时间、确诊时间和初始正确治疗时间可能比B组更短（P < 0.05）。与B组和C组相比，A组对检查方法的诊断率明显更低（P < 0.05）。生存组的右膈肌移位和左膈肌移位可能高于肺部超声评分（LUS）（P < 0.05）。相比之下，生存组的肺部超声评分（LUS）明显低于死亡组。统计分析表明，与LUS评分相比，右膈肌移位、左膈肌移位和平均膈肌移位的预测价值显著。受试者工作特征曲线的结果表明，右、左和平均膈肌移位具有较高的预测价值。
在对合并呼吸衰竭的严重多发伤患者进行早期评估时，肺部超声检查联合动脉血气分析对于患者的快速诊断和预后预测至关重要。
