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中华实验和临床感染病杂志(电子版) ›› 2021, Vol. 15 ›› Issue (01) : 37 -45. doi: 10.3877/cma.j.issn.1674-1358.2021.01.007

所属专题: 文献

论著

新型冠状病毒肺炎患者肺部超声特征
林军1, 李焕兴1, 罗槑2, 陈竹2, 吴桂辉3, 曾义岚4,()   
  1. 1. 610066 成都市,四川省成都市公共卫生临床医疗中心功能检查室
    2. 610066 成都市,四川省成都市公共卫生临床医疗中心科教部
    3. 610066 成都市,四川省成都市公共卫生临床医疗中心结核科
    4. 610066 成都市,四川省成都市公共卫生临床医疗中心肝病科
  • 收稿日期:2020-03-27 出版日期:2021-02-15
  • 通信作者: 曾义岚
  • 基金资助:
    国家中医药管理局中西医结合治疗不同分型新型冠状病毒肺炎的临床疗效及安全性评价研究(No.2020ZYLCYJ05-13); 成都市科学技术局新型冠状病毒感染肺炎患者快速筛查体系建立及疫情预测指标筛选项目(No.2020-YF05-00034-SN)

Features of lung ultrasonography of patients with coronavirus disease 2019

Jun Lin1, Huanxin Li1, Mei Luo2, Zhu Chen2, Guihui Wu3, Yilan Zeng4,()   

  1. 1. Department of Functional Rooms, Public Health Clinical Medical Center of Chengdu, Chengdu 610066, China
    2. Department of Education and Science, Public Health Clinical Medical Center of Chengdu, Chengdu 610066, China
    3. Department of Tuberculosis Treatment, Public Health Clinical Medical Center of Chengdu, Chengdu 610066, China
    4. Department of Hepatitis Treatment, Public Health Clinical Medical Center of Chengdu, Chengdu 610066, China
  • Received:2020-03-27 Published:2021-02-15
  • Corresponding author: Yilan Zeng
引用本文:

林军, 李焕兴, 罗槑, 陈竹, 吴桂辉, 曾义岚. 新型冠状病毒肺炎患者肺部超声特征[J/OL]. 中华实验和临床感染病杂志(电子版), 2021, 15(01): 37-45.

Jun Lin, Huanxin Li, Mei Luo, Zhu Chen, Guihui Wu, Yilan Zeng. Features of lung ultrasonography of patients with coronavirus disease 2019[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2021, 15(01): 37-45.

目的

评价新型冠状病毒肺炎(COVID-19)患者肺部超声特征,并探讨其临床应用价值。

方法

回顾性分析2020年1月23日~2月25日成都市公共卫生临床医疗中心收治的26例COVID-19患者入院第1天的床旁肺超声及其相关临床资料,分析患者双肺10个扫查区域的"B线"、实变和"白肺"等病理性肺超声特征。依据国家卫生健康委员会新型冠状病毒肺炎诊疗方案(试行第6版),将患者分成普通型组(13例)和危重型组13例(包括重型4例和危重型9例),比较两组患者的基线资料、肺部CT和肺部超声特征。应用Kappa检验分析肺部CT与肺超声诊断肺实变和胸水的一致性,并计算其一致性比例。分别对每位患者的肺部超声和CT进行肺部病变严重性积分,并对肺部超声和CT积分进行Pearson相关性分析。

结果

26例COVID-19患者中,男性14例,女性12例,平均年龄(48.25 ± 16.43)岁,其肺部超声显示"B线"、实变和"白肺"的发生率分别为92.3%(24/26)、69.2%(18/26)和46.2%(12/26)。危重型组患者中出现肺实变及多发性肺实变的例数显著多于普通型组[12例(92.3%) vs. 4例(30.8%),P = 0.004;9例(69.2%) vs. 2例(15.4%),P = 0.015]。"白肺"仅见于危重型组患者(12/13、92.3%)。危重型组患者的肺超声积分亦显著高于普通型组(18.62 ± 5.35)vs. (4.46 ± 1.71),t = -9.089、P < 0.001)。肺超声和肺CT发现肺实变和胸水的一致性较好(渐进P均< 0.001,一致性比例均> 0.8)。肺部超声积分与CT积分评价肺损伤严重程度的相关性较好(r = 0.985,P < 0.001)。

结论

实变和"白肺"是重型和危重型COVID-19患者的典型肺部超声特征。本研究证实肺超声是反映COVID-19患者肺损伤严重程度的可靠技术手段。

Objective

To estimate the characteristics and value of lung ultrasonography of patients with coronavirus disease 2019 (COVID-19) for clinical practice.

Methods

The bedside pulmonary ultrasound and related clinical data of 26 patients with COVID-19 admitted to Public Health Clinical Center of Chengdu from January 23rd to February 25th, 2020 were analyzed, retrospectively. Pathological pulmonary ultrasound features such as "B-line" , consolidation and "white lung" in 10 scan areas of the patients’ double lungs were analyzed. The patients were divided into moderate group (13 cases) and critical group (including 4 severe cases and 9 critical cases) according to diagnosis and treatment protocol of COVID-19 (trial version 6) of National Health Commission of China, and the baseline data, lung CT and pulmonary ultrasound characteristics between the two groups were compared. The consistency of lung CT and lung ultrasound in diagnosing lung consolidation and pleural effusion were analyzed by Kappa test, and the consistency ratio was also calculated. The pulmonary ultrasound and CT scores of each patient’s pulmonary lesion severity were performed, and Pearson correlation analysis between the pulmonary ultrasound and CT scores was performed.

Results

Among the 26 patients with COVID-19, 14 males and 12 females, with an average age of (48.25 ± 16.43) years old. The incidences of pulmonary ultrasound showing "B-line" , consolidation and "white lung" were 92.3% (24/26), 69.2% (18/26) and 46.2% (12/26), respectively. The numbers of patients with lung consolidation and multiple lung consolidation in critical group were significantly higher than those of moderate group [12 (92.3%) vs. 4 (30.8%): P = 0.004; 9 (69.2%) vs. 2 (15.4%): P = 0.015]. "White lung" was only found in critical group (12/13, 92.3%). The pulmonary ultrasound score in critical group was also significantly higher than that in moderate group (18.62 ± 5.35) vs. (4.46 ± 1.71): t =-9.089, P < 0.001). Pulmonary ultrasound and lung CT showed good consistency between lung consolidation and pleural effusion (progressive P < 0.001, consistency ratio > 0.8). There was a good correlation between lung ultrasound score and CT score in evaluating the severity of lung injury (r = 0.985, P < 0.001).

Conclusions

Lung consolidation and "white lung" were typical pulmonary sonographic features in patients with severe and critical COVID-19 in lung ultrasonography. This study confirmed that pulmonary ultrasound was a reliable technique to reflect the severity of lung injury of patients with COVID-19.

表1 危重型组和普通型组COVID-19患者入院24 h内基线资料和肺部CT特征
表2 普通型组与危重型组COVID-19患者入院24 h内肺超声特征
图1 典型病例1肺部超声声像图和肺部CT
图2 典型病例2肺部超声声像图和肺部CT
图3 典型病例3肺部超声声像图和肺部CT图
表3 肺部CT与肺部超声诊断肺实变和胸水一致性[例(%)]
图4 26例新型冠状病毒肺炎患者肺部CT与肺部超声积分的相关性
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