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重症患者床旁超声显示双肺不对称征象的临床意义

Clinical significance of bilateral lung asymmetry signs of bedside ultrasound in severe patients

摘要:

目的:探讨床旁超声显示双肺不对称征象的临床意义,以期对肺部疾病的诊治及肺部超声检查流程加以改进。方法:回顾性分析2017年9月至2019年5月入住青岛大学附属医院重症医学科肺部超声提示双肺不对称征象患者的超声影像资料。收集患者临床资料,并对肺部超声影像资料与临床诊断进行整理分析。结果:共查阅535例重症患者的超声影像资料,排除无法获得清晰肺部超声图像及双肺对称征象患者469例,最终共66例在住院过程中超声显示双肺不对称征象的患者被纳入分析,其中以单侧胸膜滑动征消失或肺点为表现的气胸占25.76%(17例),以单侧局灶性B线、碎片征、组织样征为表现的肺炎占18.18%(12例),31.82%表现为单侧液性暗区的胸腔积液(21例),以单侧局部肺实变及支气管充液征等为表现的痰液阻塞致肺不张占12.12%(8例),以单侧肺搏动征为表现的气管插管过深占7.58%(5例),上述超声诊断均经X线胸片、胸部CT、纤维支气管镜及实验室检查结果确诊;1例单侧局灶性B线患者转外院治疗,2例单侧胸膜滑动征消失或单侧肺搏动征患者猝死,临床未能明确诊断(占4.54%)。结论:肺部超声不对称征象提示患者存在需及时处理的肺部疾病;双侧对比的肺部超声检查流程有助于临床诊断。

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abstracts:

Objective:To study the clinical significance of bilateral asymmetric signs of lungs of bedside ultrasound in order to improve the diagnosis and treatment of pulmonary diseases and protocol of pulmonary ultrasound.Methods:The ultrasound imaging data of patients admitted to the department of critical care medicine of the Affiliated Hospital of Qingdao University from September 2017 to May 2019 were retrospectively analyzed. The clinical data of patients were collected, and the lung ultrasound image data and clinical diagnosis were sorted and analyzed.Results:A total of 535 critical patients ultrasound imaging data were reviewed, and 469 patients who were unable to obtain clear lung ultrasound images and lung symmetry signs were excluded. Finally, a total of 66 patients with ultrasound bilateral lung asymmetry signs during hospitalization were enrolled in the analysis. Seventeen patients (25.76%) had pneumothorax with unilateral pleural slide or lung spot, 12 (18.18%) had pneumonia with unilateral focal B line, fragment sign and tissue like sign, 21 (31.82%) had unilateral pleural effusion with unilateral liquid dark area, 8 (12.12%) had sputum obstruction with unilateral local lung consolidation and bronchial filling sign with atelectasis, and 5 (7.58%) had deep tracheal intubation. The above ultrasonic diagnoses were confirmed by chest X-ray, chest CT, fiberoptic bronchoscopy and laboratory examination. One patient with unilateral focal B-line was transferred to another hospital for treatment, and 2 patients died of sudden death due to disappearance of unilateral pleural sliding sign or unilateral pulmonary pulsation sign. The clinical diagnosis was not clear (4.54%).Conclusion:The asymmetric signs of pulmonary ultrasound clearly indicate the existence of pulmonary diseases that need to be treated in a timely manner, and the pulmonary ultrasound examination protocol of bilateral contrast is helpful for clinical diagnosis.

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作者: 张超凡 [1] 程英春 [2] 董海 [1] 刘楠 [1] 姚波 [1] 孙强 [1]
期刊: 《中华危重病急救医学》2020年32卷9期 1118-1120页 MEDLINEISTICPKUCSCD
栏目名称: 临床经验
DOI: 10.3760/cma.j.cn121430-20200108-00117
发布时间: 2020-11-16
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