床旁超声对肺部疾病的诊断和评估价值.pdf

中国小儿急救医学2015 年6月第22 卷第6期 Chin Pediatr Emerg Med,Jun 2015,Vol.22,No.6 •375 • •专家笔谈 •超声在危重症诊治中的应用 • 床旁超声对肺部疾病的诊断和评估价值 赵醴 王莹 【摘 要】 近三十年来床旁肺部超声在急诊、重症医学领域应用日益广泛。肺部超声对多种胸 膜、肺部病变如气胸、肺炎、急性肺损伤、肺间质综合征、胸腔积液等诊断效能高,显示良好的敏感性和特 异性,并且可以引导有创操作安全进行。典型的肺部超声征象包括A 线、正弦征、肺滑行征、胸膜滑行 征、组织样征、B 线、肺火箭征、肺点、条码征、动态支气管征等。床旁急诊肺部超声方案(BLUE 方案)用 于急性呼吸衰竭患者的快速病因诊断。进一步普及应用及床旁超声监测与临床常规诊治流程有机结合 是今后发展方向,将大大提高诊断效能,促进临床诊治能力的飞速发展。 【关键词】 肺部超声；肺部疾病；床旁 Diagnostic alue ofpoint-of-care lung ultrasonography Zhao Li,Wang Ying.Department of Pediatri In- tensive Care Unit,shanghai Children＇s Medi al Center,shanghai Jiaotong University s hool of Medi ine, shanghai 200127,China Corresponding author:Wang Ying(E-mail:ywang pi u@.n) 【Abstract】 Lung ultrasound(LU )has gained increasing popularity among intensivists in recent dec- ades.Although limited by the presence of air,LU has proved to be useful in the evaluation of a number of different acute and chronic conditions,such as pneumonia,pneumothorax,acute lung injury,alveolar-intersti- tial syndrome,pleural effusion,etc,and showed a relatively higher sensitivity,specificity and diagnostic accu- racy compared to routine radiographic imaging.It is also critical in improving the safety of pleural interven- tional procedures.The most common signs for diagnosing and differential diagnosing include the pleural line, lung sliding,the A-line,the quad sign,the sinusoid sign,the fractal,and tissue-like sign,the B-line,lung rock- ets,abolished lung sliding with the barcode sign,the lung point,the dynamic air bronchogram,etc.The BLUE-protocol allows differential diagnosis of acute respiratory failure.LU is a feasible technique that can be used routinely and integrated into clinical practice in the fields of intensive care,emergency care,respirato- ry and