新型冠状病毒肺炎急诊:肺超声检查。pronósticas含义

Q4 Medicine
Mónica Contreras-Moreira , Elpidio Calvo Manuel , Joaquín Antonio Álvarez Gregori
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引用次数: 0

摘要

在COVID-19患者中,临床图像可以估计一定的检测前肺部受累概率;当结合肺部超声时,预测会增加。这提供了比胸片检查浸润更大的灵敏度,并使其有可能预测病理肺CT的结果。SARS-CoV-2肺炎的特征性表现已被描述,病变的位置与预后有关。很少有关于肺超声的预后能力的经验发表,其中不包括医院获得的实验室参数。材料和方法通过一项前瞻性、多中心、连续抽样的观察性研究,于2020年4月至7月进行,招募了263名因呼吸道感染症状而在西班牙医院急诊科就诊的成年患者。每个肺探查了6个病灶,并描述了局灶性B线、全局B线、实质实变、胸膜下实变和胸膜积液的存在或不存在。患者于同日接受胸部后前方x光检查。结果研究人群以男性为主。主要合并症为肿瘤,其次为慢性肾病和缺血性心脏病。SARS-CoV-2 RT-PCR阳性且需要入院的患者更为频繁,8%的患者死亡。病理胸片的阳性率为75%,而超声扫描的阳性率为94.59%。最常见的发现是病灶B线在R6, R3和L3区。双侧实变或单侧斑片状浸润的特异性突出,在超声中,全局B线、肺和胸膜下实变和左胸膜积液的特异性突出。结论建立了一个回归模型,该模型结合了肺部超声检查结果,并在不使用其他医院实验室检查的情况下预测到急诊科就诊的患者的入院概率。可以开发一种工具,使家庭医生能够从那些将进行门诊随访的患者中识别出高住院可能性的患者,从而优先考虑早期治疗方法或转介到急诊室。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Neumonía por COVID-19 en urgencias: ecografía pulmonar. Implicaciones pronósticas

Introduction and objectives

In COVID-19 patients, the clinical picture allows estimating a certain pre-test probability of lung involvement; prediction that increases when associating lung ultrasound. This provides greater sensitivity than chest radiography in the detection of infiltrates, and makes it possible to predict the result of pathological pulmonary CT. The characteristic findings of SARS-CoV-2 pneumonia have been described, and the location of the lesions has been related to the prognosis. Few experiences have been published on the prognostic capacity of lung ultrasound, which do not include hospital-obtained laboratory parameters.

Material and methods

Through a prospective, multicenter, observational study with consecutive sampling, carried out between April and July 2020, 263 adult patients who attended the emergency department of Spanish hospitals due to symptoms compatible with respiratory infection were recruited. Six fields per lung were explored, and the presence or absence of focal B lines, global B lines, parenchymal consolidation, subpleural consolidation, and pleural effusion were described. The patients underwent a postero-anterior chest X-ray on the same day.

Results

Males predominated in the study population. The main comorbidity was neoplasms, followed by chronic kidney disease and ischemic heart disease. Patients with a positive result for SARS-CoV-2 RT-PCR and who required admission were more frequent, and 8% died. The pathological chest x-ray was positive in 75% of the patients, compared to 94.59% of the ultrasound scans. The most frequent findings were focal B lines in zones R6, R3, and L3. The specificity of bilateral consolidation or unilateral patchy infiltrate stands out, and in ultrasound the specificity of global B lines, consolidations, both pulmonary and subpleural, and left pleural effusion.

Conclusions

A regression model has been developed that incorporates the findings of the lung ultrasound and predicts the probability of admission in patients presenting to the emergency department, without using other hospital laboratory tests. A tool can be developed that allows the family physician to identify patients with a high probability of being hospitalized from those who will have an outpatient follow-up, to prioritize an early therapeutic approach or referral to the emergency room.
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来源期刊
Medicina Clinica Practica
Medicina Clinica Practica Medicine-Medicine (all)
CiteScore
0.60
自引率
0.00%
发文量
55
审稿时长
43 days
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