通讯作者: 毛云, 94385390@sohu.com

DOI：10.12201/bmr.202412.00087

Comparison of CLAUS protocol and bedside ultrasound rapid management protocol in the etiological diagnosis of acute respiratory distress in critically ill patients in the emergency room

• 摘要：目的 探究心肺及附加超声(CLAUS)方案与床旁超声快速管理(POCURM)方案在急诊室重症患者急性呼吸困难病因诊断中的价值。方法 选取2022年1月至2024年1月我院急诊收治的242例急性呼吸困难患者为研究对象,根据出院最终诊断分为心源性呼吸困难(心源组)144例和肺源性呼吸困难(肺源组)98例。比较两组CLAUS所见,以及POCURM与CLLAUS方案诊断急性呼吸困难病因的准确性。结果 心源组患者心脏疾病史比例高于肺源组,差异有统计学意义(P<0.05)；心源组患者肺部疾病史比例低于肺源组,差异有统计学意义(P<0.05)；两组患者其余临床一般资料比较均无差异(P>0.05)。心源组患者胸膜光滑/稍增厚,滑动存在/稍减弱比例、左心功能不全、右心功能不全和肺部超声B线评分均高于肺源组患者,均差异有统计学意义(P<0.05)。POCURM方案诊断急性呼吸困难病因的灵敏度为90.28%、特异度为91.84%、漏诊率9.82%、误诊率8.16%、阳性预测值为94.20%、阴性预测值为86.54%、诊断符合率为90.91%。CLAUS方案诊断急性呼吸困难病因的灵敏度为96.53%、特异度为97.96%、漏诊率3.47%、误诊率2.04%、阳性预测值为98.58%、阴性预测值为95.05%、诊断符合率为97.11%。CLAUS方案的诊断符合率(97.11%)高于POCURM方案(90.91%)(χ2=8.253,P=0.004)。结论 CLAUS方案可有效诊断急性呼吸困难患者的具体病因,其准确率高于POCURM方案。

  关键词： 急性呼吸困难; 急诊室重症; 心肺及附加超声; 床旁超声快速管理; 诊断

   

  Abstract: Objective Exploring the comparison between cardiopulmonary and additional ultrasound (CLAUS) protocol and point-of-care ultrasound rapid management (POCURM) protocol in the etiological diagnosis of acute respiratory distress in critically ill patients in the emergency room.Methods 242 patients with acute respiratory distress admitted to the emergency department of our hospital from January 2022 to January 2024 were selected as the research subjects. According to the final diagnosis after discharge, they were divided into 144 cases of cardiogenic respiratory distress (cardiogenic group) and 98 cases of pulmonary respiratory distress (pulmonary group). Compare the findings of two CLAUS groups and the accuracy of POCURM and CLLAUS protocols in diagnosing the etiology of acute respiratory distress.Results The history of heart disease in the cardiogenic group was higher than that in the pulmonary group, and the difference was statistically significant (P<0.05); The lung disease history of patients in the cardiogenic group was lower than that in the pulmonary source group, and the difference was statistically significant (P<0.05); There was no significant difference in other clinical general data between the two groups of patients (P>0.05). The proportion of pleural smoothness/slight thickening, sliding presence/slight weakening, left heart dysfunction, right heart dysfunction, and B-line pulmonary ultrasound scores in the cardiogenic group were higher than those in the pulmonary source group, and the differences were statistically significant (P<0.05). The sensitivity, specificity, missed diagnosis rate, misdiagnosis rate, positive predictive value, negative predictive value, and diagnostic accuracy of the POURM protocol for diagnosing acute respiratory distress were 90.28%, 91.84%, 9.82%, 8.16%, 94.20%, 86.54%, and 90.91%, respectively. The sensitivity, specificity, missed diagnosis rate, misdiagnosis rate, positive predictive value, negative predictive value, and diagnostic accuracy of the CLAUS protocol for diagnosing acute respiratory distress were 96.53%, 97.96%, 3.47%, 2.04%, 98.58%, 95.05%, and 97.11%, respectively. The diagnostic accuracy of the CLAUS regimen (97.11%) was higher than that of the POURM regimen (90.91%) (χ2=8.253, P=0.004).Conclusion The CLAUS regimen can effectively diagnose the specific causes of acute respiratory distress in patients, with higher accuracy than the POCURM regimen.

  Key words: Acute respiratory distress; Emergency room critical illness; Cardiopulmonary and additional ultrasound; Point-of-Care Ultrasound Rapid Management; diagnosis

  提交时间：2024-12-31

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  1	2024-12-02	bmr.202412.00087V1	下载

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