Chinese Medical Sciences Journal ›› 2021, Vol. 36 ›› Issue (4): 257-264.doi: 10.24920/003874

• 论著 •    下一篇

床旁心脏超声结合肺部超声在重症患者中的应用: 一项全国多中心观察性研究

张宏民1,张丽娜2,刘丽霞3,朱英4,尹万红5,何伟6,尚秀玲7,晁彦公8,吕立文9,王小亭1,*,刘大为1,重症超声研究组   

  1. 1中国医学科学院北京协和医学院 北京协和医院,重症医学科,中国,北京,100730
    2中南大学湘雅医院,重症医学科,中国,长沙,410013
    3河北医科大学第四医院,重症医学科,中国,石家庄,050011
    4浙江大学医学院附属杭州第一人民医院,重症医学科,中国,杭州,310006
    5四川大学华西医院,重症医学科,中国,成都,610041
    6北京同仁医院,重症医学科,中国,北京,100730
    7福建省立医院,重症医学科,中国,福建,350001
    8清华大学第一附属医院,重症医学科,中国,北京,100016
    9广西壮族自治区人民医院,急诊科,中国,南宁,530016
  • 收稿日期:2021-01-08 出版日期:2021-12-31 发布日期:2022-01-06
  • 通讯作者: 王小亭

Effect of Focused Cardiac Ultrasound in Combination with Lung Ultrasound on Critically Ill Patients: A Multicenter Observational Study in China

Hongmin Zhang1,Lina Zhang2,Lixia Liu3,Ying Zhu4,Wanhong Yin5,Wei He6,Xiuling Shang7,Yangong Chao8,Liwen Lv9,Xiaoting Wang1,*,Dawei Liu1,Chinese Critical Ultrasound Study Group   

  1. 1Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
    2Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha 410013, China
    3Department of Critical Care Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
    4Department of Critical Care Medicine, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
    5Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
    6Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
    7Department of Critical Care Medicine, Fujian Provincial Hospital, Fuzhou 350001, China
    8Department of Critical Care Medicine, The First Hospital of Tsinghua University, Beijing 100016, China
    9Department of Emergency Medicine, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China
  • Received:2021-01-08 Published:2021-12-31 Online:2022-01-06
  • Contact: Xiaoting Wang

摘要:

目的 床旁心脏超声和肺部超声在重症患者中的应用日益广泛。本研究旨在调查心脏超声联合肺部超声在重症患者中的作用,以及超声检查时机与治疗改变是否有关。
方法 本研究为多中心横断面观察性研究。连续收入重症医学科住院患者,在24 h内行床旁心脏超声和肺部超声检查,操作者根据患者的临床情况和超声检查结果做出是否需要改变治疗的判断。
结果 在收入的992例患者中,502例患者(早期组)在入科6 h内完成超声检查,490例患者(后期组)在入科6 h后完成超声检查。早期组和后期组治疗改变的比例接近(48.8%比49.0%,χ2=0.003,P=0.956)。多元分析表明,因呼吸衰竭入院是治疗改变的独立影响因素(OR=2.357,95%置信区间:1.284-4.326,P=0.006);超声检查时机不是治疗改变的影响因素(OR=0.725,95%置信区间:0.407-1.291,P=0.275)。
结论 床旁心脏超声结合肺部超声检查能显著改变重症患者的治疗,而且24h内早期检查和后期检查均有作用。超声检查更容易给呼吸衰竭患者带来治疗改变。

关键词: 心脏超声, 肺部超声, 重症患者, 床旁

Abstract:

Objective Focused cardiac ultrasound (FCU) and lung ultrasound (LU) are increasingly being used in critically ill patients. This study aimed to investigate the effect of FCU in combination with LU on these patients and to determine if the timing of ultrasound examination was associated with treatment change.
Methods This is a multicenter cross-sectional observational study. Consecutive patients admitted to the intensive care unit (ICU) were screened for enrollment. FCU and LU were performed within the first 24 h, and treatment change was proposed by the performer based on the ultrasound results and other clinical conditions.
Results Among the 992 patients included, 502 were examined within 6 h of ICU admission (early phase group), and 490 were examined after 6 h of admission (later phase group). The early phase group and the later phase group had similar proportions of treatment change (48.8% vs. 49.0%, χ 2=0.003, P=0.956). In the multivariable analysis, admission for respiratory failure was an independent variable associated with treatment change, with an odds ratio (OR) of 2.357 [95% confidence interval (CI): 1.284-4.326, P=0.006]; the timing of examination was not associated with treatment change (OR=0.725, 95%CI: 0.407-1.291, P=0.275).
Conclusions FCU in combination with LU, whether performed during the early phase or later phase, had a significant impact on the treatment of critically ill patients. Patients with respiratory failure were more likely to experience treatment change after the ultrasound examination.

Key words: cardiac ultrasound, lung ultrasound, critically ill, point-of-care

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