肺超声对急性左心衰竭患者治疗效果及预后的影响

doi:10.3969/j.issn.1002-1949.2018.11.008

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摘要目的探讨肺超声能否用于指导急性左心衰竭患者的治疗及改善预后。方法连续入选2015-11~2017-02因急性左心衰竭入住郑州市第七人民医院心内科的患者（n=225），随机分为超声指导组（n=113）和常规治疗组（n=112）。常规治疗组按照急性心力衰竭指南给予标准化治疗，超声指导组在标准化治疗基础上应用肺超声指导治疗，分别比较两组患者住院期间及出院后13个月随访期间不良事件的发生率。结果在住院期间，超声指导组急性肾损伤比例低于常规治疗组［23.0%（26/113）vs. 33.9%（38/112），P＜0.05］，心源性休克比例低于常规治疗组［10.7%（12/113）vs. 23.2%（26/112），P＜0.01］，CCU平均住院时间小于常规治疗组［（2.3±0.2）d vs.（3.7±0.3）d，P＜0.001］，CCU平均住院费用小于常规治疗组［（6674.5±1143.6）元 vs.（8759.7±1257.4）元，P＜0.05］，CCU日均利尿剂用量少于常规治疗组［（36.6±8.4）mg vs.（68.6±11.7）mg，P＜0.001］，两组间全因死亡比例、恶性心律失常比例、CCU日均液体输注量及24 h乳酸清除率差异无统计学意义（P均＞0.05）。在随访期间，超声指导组和常规治疗组的全因病死率差异无统计学意义［13.3%（15/113）vs. 18.8%（21/112），P＞0.05］；超声指导组症状性心力衰竭发生率低于常规治疗组［37.2%（42/113）vs. 48.2%（54/112），P＜0.05］；因心力衰竭再入院率低于常规治疗组［19.5%（22/113）vs. 40.2%（45/112），P＜0.01］；肾衰竭需肾脏替代治疗发生率低于常规治疗组［3.5%（4/113）vs. 11.6%（13/112），P＜0.001］。结论肺超声的应用能减少急性左心衰竭患者住院期间急性肾损伤及心源性休克的发生，减少CCU住院时间及住院费用，减少出院后急性心力衰竭的复发及再入院比例，减少肾衰竭需肾脏替代治疗的比例，但不能降低患者短期及长期病死率。

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	丁琦
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关键词 ：肺超声, 急性左心衰竭, 预后

通讯作者: 王淑红（1971-），女，硕士，主任医师，E-mail:wsh1183@163.com。

作者简介: 丁琦（1989-），男，硕士，主治医师，E-mail:1010881835@qq.com。

引用本文:

丁琦，王淑红，黄新新，冯晔子，张欢欢，黄琼，于慧娟，袁义强. 肺超声对急性左心衰竭患者治疗效果及预后的影响[J]. 中国急救医学, 2018, 38(11): 958-963.
Ding Qi, Wang Shu-hong, Huang Xin-xin, Feng Ye-zi, Zhang Huan-huan, Huang Qiong, Yu Hui-juan, Yuan Yi-qiang. Impact of lung ultrasound on treatment and prognosis in patients with acute left heart failure. Chinese Journal of Critical Care Medicine, 2018, 38(11): 958-963.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2018.11.008 或 http://www.cnemergency.org.cn/CN/Y2018/V38/I11/958

［1］Sobczyk D, Nycz K, Andruszkiewicz P. Validity of a 5-minute focused echocardiography with A-F mnemonic performed by non-echocardiographers in the management of patients with acute chest pain［J］. Cardiovasc Ultrasound, 2015,13:16.  ［2］De Backer D. Ultrasonic evaluation of the heart［J］. Curr Opin Crit Care, 2014, 20(3):309-314.  ［3］Krishnan S, Schmidt GA. Acute right ventricular dysfunction: realtime management with echocardiography［J］. Chest, 2015,147(3):835-846.  ［4］王小亭，刘大为. 重症超声是整合重症医学的有力武器［J］.中华内科杂志, 2013, 52(8):631-633. ［5］Volpicelli G, Elbarbary M, Blaivas M, et al. International evidence-based recommendations for point-of-care lung ultrasound［J］. Intensive Care Med, 2012, 38(4):577-591.  ［6］Saraogi A.Lung ultrasound: Present and future［J］. Lung India, 2015, 32(3):250-257.  ［7］Lichtenstein DA. Lung ultrasound in the critically ill［J］. Ann Intensive Care, 2014, 4(1):1.  ［8］中华医学会心血管病学分会，中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2014［J］.中华心血管病杂志, 2014, 42(2)：98-122. ［9］Enghard P, Rademacher S, Nee J, et al. Simplified lung ultrasound protocol shows excellent prediction of extravascular lung water inventilated intensive care patients［J］. Crit Care, 2015, 19:36. ［10］Anile A, Russo J, Castiglione G,et al. A simplified lung ultrasound approach to detect increased extravascular lung water in critically ill patients［J］. Crit Ultrasound J, 2017, 9(1):13. ［11］Baldi G, Gargani L, Abramo A, et al. Lung water assessment by lung ultrasonography in intensive care: a pilot study［J］. Intensive Care Med, 2013, 39(1):74-84. ［12］Gargani L. Lung ultrasound: a new tool for the cardiologist［J］. Cardiovasc Ultrasound, 2011, 9:6. ［13］Frassi F, Gargani L, Gligorova S, et al. Clinical and echocardiographic determinants of ultrasound lung comets［J］. Eur J Echocardiogr, 2007, 8(6):474-479. ［14］Jambrik Z, Monti S, Coppola V, et al. Usefulness of ultrasound lung comets as a nonradiologic sign of extravascular lung water［J］. Am J Cardiol, 2004, 93(10):1265-1270. ［15］Agricola E, Bove T, Oppizzi M, et al.“Ultrasound comet-tail images": a marker of pulmonary edema: a comparative study with wedge pressure and extravascular lung water［J］. Chest, 2005, 127(5):1690-1695. ［16］Gargani L, Frassi F, Soldati G, et al. Ultrasound lung comets for the differential diagnosis of acute cardiogenic dyspnoea: a comparison with natriuretic peptides［J］. Eur J Heart Fail, 2008, 10(1):70-77. ［17］Bennett VA, Vidouris A, Cecconi M. Effects of Fluids on the Macro- and Microcirculations［J］. Crit Care, 2018, 22(1):74. ［18］Picano E, Scali MC. The lung water cascade in heart failure［J］. Echocardiography, 2017, 34(10):1503-1507. ［19］Picano E, Gargani L, Gheorghiade M.Why, when, and how to assess pulmonary congestion in heart failure: pathophysiological, clinical, and methodological implications［J］. Heart Fail Rev, 2010, 15(1):63-72. ［20］Mallamaci F, Benedetto FA, Tripepi R, et al. Detection of pulmonary congestion by chest ultrasound in dialysis patients［J］. JACC Cardiovasc Imaging, 2010, 3(6):586-594. ［21］Palazzuoli A, Ruocco G, Beltrami M, et al. Combined use of lung ultrasound,B-type natriuretic peptide,and echocardiography for outcomeprediction in patients with acute HFrEF and HFpEF［J］. Clin Res Cardiol, 2018, 107(7):586-596. ［22］Saad MM, Kamal J, Moussaly E, et al. Relevance of B-Lines on Lung Ultrasound in Volume Overload and Pulmonary Congestion: Clinical Correlations and Outcomes in Patients on Hemodialysis［J］. Cardiorenal Med, 2017, 8(2):83-91.