床旁超声和胸部X线检查在重症肺炎诊断中的临床对比观察(1)
DOI：10.3760/cma.j.issn.1671-0282.2014.12.015
基金项目：国家临床重点专科建设项目;留学人员科技活动项目择优资助
作者单位：100029 北京，中日友好医院急诊科，张山红和张洪波为共同第一作者
通信作者：张洪波，Email：jhzhb@126.com
【摘要】目的分析重症肺炎患者的肺部超声特征，探讨床旁超声诊断肺炎的临床价值。方法以急诊留院治疗的疑诊重症肺炎患者为研究对象，对患者进行胸部X线检查(chest x-ray CXR)、肺部超声检查及胸部CT检查;分析床旁超声诊断重症肺炎的敏感性、特异性、阳性预测值、阴性预测值及准确性，并与CXR进行比较。结果重症肺炎组出现肺实变的患者例数、有胸膜改变的肋间个数、胸膜下病变个数以及合并有胸腔积液的患者例数均高于非重症肺炎组。床旁超声诊断重症肺炎的敏感性为95.7%，特异性为97.1%，阳性预测值为98.5%，阴性预测值为89.5%，准确性为96.2%。与CXR比较，两者在敏感性、阴性预测值和准确性上差异具有统计学意义。结论床旁超声是诊断重症肺炎可靠的辅助检查方法，诊断的敏感性、阴性预测值和准确性优于CXR，广泛地开展胸部床旁超声检查可以提高重症肺炎的快速诊断，确立及时正确的治疗。
, 百拇医药
【关键词】超声检查;胸部X线检查;重症肺炎
Comparison of diagnostic performances between bedside sonography and chest x-ray in severe pneumonia
ZHANG Shanhong，ZHANG Hongbo，LIU Xiaolei，ZHANG Guoqiang. Emergency Department，China-Japan Friendship Hospital，Beijing 100029，China
Corresponding author：Zhang Hongbo，Email：jhzhb@126.com
【Abstract】ObjectiveTo evaluate the diagnostic performances of bedside lung ultrasound (US) and chest radiography (CXR) in patients with severe pneumonia. Method Lung ultrasound(US)，CXR and chest CT were performed in sequence in adult patients admitted to the emergency department for suspected acute respiratory failure caused by severe pneumonia. Here， chest CT served as a"golded standard" for comparison.The diagnostic efficacy of US for the detection of severe pneumonia， defined as rapidity and accuracy (sensitivity， specificity， positive predictive value， negative predictive value) were compared with CXR. Results The number of patients with consolidation of lung， pleural alteration， subpleural pathological changes， and pleural effusion in the severe pneumonia group was higher than that in the non-pneumonia group. Sensitivity of bedside ultrasound examination for the diagnosis of severe pneumonia was 95.7%， and specificity 96.3%， positive predictive value 95.7%， negative predictive value 96.3%， and accuracy 96.0%. There were differences in sensitivity， negative predictive value and accuracy found between CXR and US. Conclusions Bedside chest ultrasound is a reliable device for the diagnosis of severe pneumonia， and superior to CXR in this setting， allowing a more prompt diagnosis and treatment.
【Key words】Ultrasonic inspection;Chest X-ray;Severe pneumonia
重症肺炎导致的急性呼吸衰竭是急诊常见的危重症，目前常用的诊断肺炎的手段包括胸部X线(CXR)和CT。CT常作为肺炎诊断的“金标准”[1]，但部分患者因为病情严重，不易挪动，或需要较高条件的呼吸机支持，可能无法完成CT检查。超声作为一种无创、快速的检查手段正在临床被越来越多的使用，尤其在急诊抢救室和重症监护病房，在对重症患者的检查诊断和胸部影像动态观察中显示出了其安全、快捷、准确的特性[2-3]。本文通过观察69例重症肺炎患者的肺部超声特点，探讨超声影像检查在重症肺炎的应用价值。, 百拇医药(张山红 张洪波 刘笑雷 张国强)
基金项目：国家临床重点专科建设项目;留学人员科技活动项目择优资助
作者单位：100029 北京，中日友好医院急诊科，张山红和张洪波为共同第一作者
通信作者：张洪波，Email：jhzhb@126.com
【摘要】目的分析重症肺炎患者的肺部超声特征，探讨床旁超声诊断肺炎的临床价值。方法以急诊留院治疗的疑诊重症肺炎患者为研究对象，对患者进行胸部X线检查(chest x-ray CXR)、肺部超声检查及胸部CT检查;分析床旁超声诊断重症肺炎的敏感性、特异性、阳性预测值、阴性预测值及准确性，并与CXR进行比较。结果重症肺炎组出现肺实变的患者例数、有胸膜改变的肋间个数、胸膜下病变个数以及合并有胸腔积液的患者例数均高于非重症肺炎组。床旁超声诊断重症肺炎的敏感性为95.7%，特异性为97.1%，阳性预测值为98.5%，阴性预测值为89.5%，准确性为96.2%。与CXR比较，两者在敏感性、阴性预测值和准确性上差异具有统计学意义。结论床旁超声是诊断重症肺炎可靠的辅助检查方法，诊断的敏感性、阴性预测值和准确性优于CXR，广泛地开展胸部床旁超声检查可以提高重症肺炎的快速诊断，确立及时正确的治疗。
, 百拇医药
【关键词】超声检查;胸部X线检查;重症肺炎
Comparison of diagnostic performances between bedside sonography and chest x-ray in severe pneumonia
ZHANG Shanhong，ZHANG Hongbo，LIU Xiaolei，ZHANG Guoqiang. Emergency Department，China-Japan Friendship Hospital，Beijing 100029，China
Corresponding author：Zhang Hongbo，Email：jhzhb@126.com
【Abstract】ObjectiveTo evaluate the diagnostic performances of bedside lung ultrasound (US) and chest radiography (CXR) in patients with severe pneumonia. Method Lung ultrasound(US)，CXR and chest CT were performed in sequence in adult patients admitted to the emergency department for suspected acute respiratory failure caused by severe pneumonia. Here， chest CT served as a"golded standard" for comparison.The diagnostic efficacy of US for the detection of severe pneumonia， defined as rapidity and accuracy (sensitivity， specificity， positive predictive value， negative predictive value) were compared with CXR. Results The number of patients with consolidation of lung， pleural alteration， subpleural pathological changes， and pleural effusion in the severe pneumonia group was higher than that in the non-pneumonia group. Sensitivity of bedside ultrasound examination for the diagnosis of severe pneumonia was 95.7%， and specificity 96.3%， positive predictive value 95.7%， negative predictive value 96.3%， and accuracy 96.0%. There were differences in sensitivity， negative predictive value and accuracy found between CXR and US. Conclusions Bedside chest ultrasound is a reliable device for the diagnosis of severe pneumonia， and superior to CXR in this setting， allowing a more prompt diagnosis and treatment.
【Key words】Ultrasonic inspection;Chest X-ray;Severe pneumonia
重症肺炎导致的急性呼吸衰竭是急诊常见的危重症，目前常用的诊断肺炎的手段包括胸部X线(CXR)和CT。CT常作为肺炎诊断的“金标准”[1]，但部分患者因为病情严重，不易挪动，或需要较高条件的呼吸机支持，可能无法完成CT检查。超声作为一种无创、快速的检查手段正在临床被越来越多的使用，尤其在急诊抢救室和重症监护病房，在对重症患者的检查诊断和胸部影像动态观察中显示出了其安全、快捷、准确的特性[2-3]。本文通过观察69例重症肺炎患者的肺部超声特点，探讨超声影像检查在重症肺炎的应用价值。, 百拇医药(张山红 张洪波 刘笑雷 张国强)