Point-of-care ultrasonography(POCUS)is increasingly recognized as a valuable extension of the physical exam,offering real-time bedside insights to support clinical decision-making.In nephrology,lung ultrasound(LUS)is ...Point-of-care ultrasonography(POCUS)is increasingly recognized as a valuable extension of the physical exam,offering real-time bedside insights to support clinical decision-making.In nephrology,lung ultrasound(LUS)is gaining prominence for its ability to assess extravascular lung water and guide fluid management,especially in patients with end-stage renal disease.This narrative review highlights current applications,technical aspects,and limitations of LUS in nephrology.Studies such as the Lung Water by Ultrasound-Guided Treatment in Haemodialysis Patients trial indicate that LUS-guided ultrafiltration may help improve blood pressure control,reduce pulmonary congestion and acute heart failure events in dialysis patients.Simplified approaches like the 8-zone protocol have shown diagnostic accuracy comparable to the traditional 28-zone method,improving feasibility in clinical practice.Nonetheless,limitations exist,including reduced specificity in non-cardiogenic lung conditions and under recognition of right-sided congestion when used in isolation.A comprehensive hemodynamic assessment requires integrating LUS with inferior vena cava ultrasound,focused cardiac ultrasound,and venous Doppler.Successful implementation depends on structured training and an understanding of potential interpretation challenges.Looking ahead,streamlined protocols,multimodal integration,and standardized training will be key to establishing POCUS as a core tool in nephrology.展开更多
目的研究肺部超声B线评分联合膈肌功能相关参数对重症机械通气患者撤机成功的预测价值。方法选取2021年4月至2023年8月我院收治的重症机械通气患者115例,针对符合撤机条件患者行肺超声检查计算B线评分,并用T管行自主呼吸实验(spontaneou...目的研究肺部超声B线评分联合膈肌功能相关参数对重症机械通气患者撤机成功的预测价值。方法选取2021年4月至2023年8月我院收治的重症机械通气患者115例,针对符合撤机条件患者行肺超声检查计算B线评分,并用T管行自主呼吸实验(spontaneous breathing trial,SBT),SBT 30 min时通过床旁超声获取右侧膈肌移动度、膈肌厚度,计算呼吸浅快指数、膈肌呼吸浅快指数、膈肌厚度变化率。以患者撤机后48 h呼吸状况分为撤机成功组78例和撤机失败组37例,收集患者临床资料。通过多元logistic回归分析影响撤机成功的相关因素,并通过受试者工作特征曲线(receiver operating characteristic,ROC)评估肺部超声B线评分联合膈肌功能相关参数对撤机的预测价值。结果撤机失败组肺部超声B线评分、膈肌呼吸浅快指数大于撤机成功组,右侧膈肌移动度、膈肌厚度变化率小于撤机成功组(P<0.05)。撤机失败组急性生理学与慢性健康状况评分系统Ⅱ(Acute Physiology and Chronic Health Evaluation,APACHE-Ⅱ)评分、序贯器官衰竭评分(Sequen⁃tial Organ Failure Assessment,SOFA)、呼吸频率、呼吸浅快指数高于撤机成功组,机械通气时间少于撤机成功组(P<0.05)。经logistic回归结果得出,肺部超声B线评分、膈肌呼吸浅快指数、右侧膈肌移动度、膈肌厚度变化率、APACHE-Ⅱ评分、SOFA评分、呼吸频率、呼吸浅快指数是撤机成功重要影响因素(P<0.05)。经ROC曲线分析得出,肺部超声B线评分、膈肌呼吸浅快指数、右侧膈肌移动度、膈肌厚度变化率联合预测曲线下面积(area under curve,AUC)为0.931,优于单一预测结果(P<0.05)。结论肺部超声B线评分联合膈肌功能相关参数对重症机械通气患者撤机成功的预测价值较高。展开更多
目的探讨后外侧肺泡和/或胸膜综合征点(PLAPS点)B线数量在急性脑出血患者早期病程中的变化规律,评估其在神经源性肺水肿(NPE)早期诊断中的应用价值。方法回顾性分析2024年1~10月重庆市第七人民医院收治的40例急性脑出血患者,根据是否并...目的探讨后外侧肺泡和/或胸膜综合征点(PLAPS点)B线数量在急性脑出血患者早期病程中的变化规律,评估其在神经源性肺水肿(NPE)早期诊断中的应用价值。方法回顾性分析2024年1~10月重庆市第七人民医院收治的40例急性脑出血患者,根据是否并发NPE的情况将急性脑出血患者分为NPE组(n=24)和无肺水肿组(n=16),对患者进行PLAPS点床旁肺部超声扫查,并记录各患者B线数量。结果NPE组的B线数量高于无肺水肿组(5.13±1.22 vs 2.32±1.41,P<0.01)。ROC曲线分析显示,PLAPS点B线数量诊断NPE的敏感度为92.50%,特异度为86.42%,截断值为3.5条。观察发现部分NPE患者左侧PLAPS点B线数量普遍高于右侧。结论PLAPS点B线数量在NPE诊断中具有较高的敏感度和特异度,尤其适用于急性脑出血患者的早期识别。左侧B线数量可能更敏感反映肺部液体积聚,有助于优化超声评估策略,建议在临床实践中推广使用。展开更多
文摘Point-of-care ultrasonography(POCUS)is increasingly recognized as a valuable extension of the physical exam,offering real-time bedside insights to support clinical decision-making.In nephrology,lung ultrasound(LUS)is gaining prominence for its ability to assess extravascular lung water and guide fluid management,especially in patients with end-stage renal disease.This narrative review highlights current applications,technical aspects,and limitations of LUS in nephrology.Studies such as the Lung Water by Ultrasound-Guided Treatment in Haemodialysis Patients trial indicate that LUS-guided ultrafiltration may help improve blood pressure control,reduce pulmonary congestion and acute heart failure events in dialysis patients.Simplified approaches like the 8-zone protocol have shown diagnostic accuracy comparable to the traditional 28-zone method,improving feasibility in clinical practice.Nonetheless,limitations exist,including reduced specificity in non-cardiogenic lung conditions and under recognition of right-sided congestion when used in isolation.A comprehensive hemodynamic assessment requires integrating LUS with inferior vena cava ultrasound,focused cardiac ultrasound,and venous Doppler.Successful implementation depends on structured training and an understanding of potential interpretation challenges.Looking ahead,streamlined protocols,multimodal integration,and standardized training will be key to establishing POCUS as a core tool in nephrology.
文摘目的研究肺部超声B线评分联合膈肌功能相关参数对重症机械通气患者撤机成功的预测价值。方法选取2021年4月至2023年8月我院收治的重症机械通气患者115例,针对符合撤机条件患者行肺超声检查计算B线评分,并用T管行自主呼吸实验(spontaneous breathing trial,SBT),SBT 30 min时通过床旁超声获取右侧膈肌移动度、膈肌厚度,计算呼吸浅快指数、膈肌呼吸浅快指数、膈肌厚度变化率。以患者撤机后48 h呼吸状况分为撤机成功组78例和撤机失败组37例,收集患者临床资料。通过多元logistic回归分析影响撤机成功的相关因素,并通过受试者工作特征曲线(receiver operating characteristic,ROC)评估肺部超声B线评分联合膈肌功能相关参数对撤机的预测价值。结果撤机失败组肺部超声B线评分、膈肌呼吸浅快指数大于撤机成功组,右侧膈肌移动度、膈肌厚度变化率小于撤机成功组(P<0.05)。撤机失败组急性生理学与慢性健康状况评分系统Ⅱ(Acute Physiology and Chronic Health Evaluation,APACHE-Ⅱ)评分、序贯器官衰竭评分(Sequen⁃tial Organ Failure Assessment,SOFA)、呼吸频率、呼吸浅快指数高于撤机成功组,机械通气时间少于撤机成功组(P<0.05)。经logistic回归结果得出,肺部超声B线评分、膈肌呼吸浅快指数、右侧膈肌移动度、膈肌厚度变化率、APACHE-Ⅱ评分、SOFA评分、呼吸频率、呼吸浅快指数是撤机成功重要影响因素(P<0.05)。经ROC曲线分析得出,肺部超声B线评分、膈肌呼吸浅快指数、右侧膈肌移动度、膈肌厚度变化率联合预测曲线下面积(area under curve,AUC)为0.931,优于单一预测结果(P<0.05)。结论肺部超声B线评分联合膈肌功能相关参数对重症机械通气患者撤机成功的预测价值较高。
文摘目的探讨后外侧肺泡和/或胸膜综合征点(PLAPS点)B线数量在急性脑出血患者早期病程中的变化规律,评估其在神经源性肺水肿(NPE)早期诊断中的应用价值。方法回顾性分析2024年1~10月重庆市第七人民医院收治的40例急性脑出血患者,根据是否并发NPE的情况将急性脑出血患者分为NPE组(n=24)和无肺水肿组(n=16),对患者进行PLAPS点床旁肺部超声扫查,并记录各患者B线数量。结果NPE组的B线数量高于无肺水肿组(5.13±1.22 vs 2.32±1.41,P<0.01)。ROC曲线分析显示,PLAPS点B线数量诊断NPE的敏感度为92.50%,特异度为86.42%,截断值为3.5条。观察发现部分NPE患者左侧PLAPS点B线数量普遍高于右侧。结论PLAPS点B线数量在NPE诊断中具有较高的敏感度和特异度,尤其适用于急性脑出血患者的早期识别。左侧B线数量可能更敏感反映肺部液体积聚,有助于优化超声评估策略,建议在临床实践中推广使用。
