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

doi:10.24920/003874

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

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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:2021-10-09
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 Wang^1,^*,Dawei Liu¹,Chinese Critical Ultrasound Study Group

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:2021-10-09
Contact: Xiaoting Wang

摘要/Abstract

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

Hongmin Zhang, Lina Zhang, Lixia Liu, Ying Zhu, Wanhong Yin, Wei He, Xiuling Shang, Yangong Chao, Liwen Lv, Xiaoting Wang, Dawei Liu, Chinese Critical Ultrasound Study Group . Effect of Focused Cardiac Ultrasound in Combination with Lung Ultrasound on Critically Ill Patients: A Multicenter Observational Study in China[J].Chinese Medical Sciences Journal, 2021, 36(4): 257-264.

图/表 5

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Items	Early phase (n=502)	Later phase (n=490)	t or Z or χ²	P
Male [n (%)]	287 (57.2)	301 (61.4)	1.862	0.172
Age (yr, mean±SD)	61±18	59±17	1.849	0.064
APACHEⅡ	15 (11, 21)	17 (11, 23)	-0.924	0.270
SOFA [score, median (interquartile range)]	6 (4, 8)	6 (4, 8)	-0.662	0.508
Diagnosis [n (%)]
High risk surgery	183 (36.5)	187 (37.8)	0.310	0.578
Respiratory failure	130 (25.9)	152 (31.0)	3.200	0.074
Shock	84 (16.7)	66 (13.5)	2.058	0.151
Shock+Respiratory failure	39 (7.8)	29 (5.9)	1.330	0.249
Others^*	118 (23.5)	114 (23.3)	0.008	0.929
HR [bpm, median (interquartile range)]	92 (77, 114)	98 (79, 110)	-0.012	0.991
MAP [mmHg, median (interquartile range)]	88 (77, 102)	88 (80, 98)	-0.273	0.785
NE infusion [n, (%)]	103 (20.5)	115 (23.5)	0.725	0.124
MV [n, (%)]	264 (52.6)	279 (56.9)	1.893	0.169

Items	Early phase (n=502)	Later phase (n=490)	Z or χ²	P
Duration of examination [min, median (interquartile range)]	15 (11, 30)	15 (12, 30)	-1.495	0.135
FCU
Structure abnormality^*	92 (18.3)	94 (19.2)	0.120	0.730
Left ventricular systolic function
Normal	364 (72.5)	343 (70.0)	0.763	0.382
Moderately abnormal	120 (23.9)	132 (26.9)	1.205	0.272
Severely abnormal	18 (3.6)	15 (3.1)	0.212	0.645
IVC
Dilated and fixed	173 (34.5)	129 (26.3)	7.751	0.005
Moderate	240 (47.8)	276 (56.3)	7.208	0.007
Small and collapsed	89 (17.7)	85 (17.3)	0.025	0.874
RV dysfunction	7 (1.4)	9 (1.8)	0.306	0.580
LU
A profile	212 (42.2)	181(36.9)	2.903	0.088
A’ or B’+lung point	8 (1.6)	11(2.2)	0.560	0.454
B profile	35 (7.0)	29 (5.9)	0.456	0.499
Other profiles^*	247 (49.2)	269 (54.9)	3.222	0.073

Items	Early phase (n=502)	Later phase (n=490)	χ²	P
Patients with treatment change	245 (48.8)	240 (49.0)	0.003	0.956
One treatment change	153 (30.5)	149 (30.4)	0.001	0.991
More than one treatment change	92 (18.3)	91 (18.6)	0.010	0.921
Volume expansion	47 (9.4)	44 (9.0)	0.044	0.835
Negative fluid balance	166 (33.1)	139 (28.4)	2.573	0.109
Inotrope	28 (5.6)	39 (8.0)	2.233	0.135
Norepinephrine adjustment	37 (7.4)	22 (4.5)	3.679	0.055
Drainage of pericardial effusion	3 (0.6)	0	2.937	0.087
Ventilator adjustment	93 (18.5)	104 (21.2)	1.135	0.287
Drainage of pleural cavity	23 (4.6)	24 (4.9)	0.055	0.815
In need of other type of ultrasound examination	91 (18.1)	97 (19.8)	0.449	0.503
In need of CT	88 (17.5)	98 (20.0)	0.993	0.319
In need of CCO monitoring	39 (7.8)	26 (5.3)	2.456	0.117

Risk factors	OR	95%CI	P
Age	0.987	0.969-1.005	0.157
APAHCEⅡ	0.997	0.991-1.003	0.379
SOFA	1.034	0.946-1.130	0.465
Respiratory failure	2.357	1.284-4.326	0.006
Shock	1.733	0.896-3.353	0.103
Timing of examination	0.725	0.407-1.291	0.275

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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

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

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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

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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