| Objects:To investigate the differential diagnosic value of the changes in lung ultrosonograghy (LUS) of dyspnea and evaluate the effects of LUS on the cardiac function of patients with heart failure.Methods:Random select a total of88patients with dyspnea admitted in the Emergency Center of Tianjin Medical University General Hospital from November2012to January2014and who with lung cancer, interstitial lung disease and renal insufficiency were excluded.All patients underwent LUS in6hours to count ultrasound lung comets (ULCs) and were divided into ULCs positive group (ULCs>5)(group A,52cases) and ULCs negative group(ULCs≤5)(group B,36cases).Then according to the characteristics of B line,the group A patinents were divided into group A1(21cases of B7line) and group A2(31cases of B3line) Description the group A and its sub group and the group B distribution of disease,and analysis of each disease apthophysiology theory of changes in LUS and differential diagnosis. After exclusion of pneumonia and ARDS patients,the patients with coronary artery disease in this study of36patients were divided into group II,III,IV according to the NYHA classification,then selected10cases of hospitalized patients with NYHA I level (excluding lung cancer, interstitial lung disease,renal insufficiency) as the group I.All groups were studied by LUS to count ULCs,left ventricular ejection fraction(EF), the ratio of early diastolic mitral inflow velocity to early diastolic velocity of the mitral annulus (E/Ea),left atrial diameter (LAD),left ventricular end diastolic diameter (LVEDD) and systolic pulmonary arterial pressure(SPAP) by transthoracic echocardiography examination, and measurement NT-proBNP levels. Comparing respectively with the number of ULCs,the value of EF, E/Ea,LAD,LVEDD,SPAP and the levels of NT-proBNP among the four group,then analyse the correlation between the ULCs and EF,E/Ea,LAD,LVEDD,NT-proBNP levels.Result:Each ULCs positive patients required inspection time is3-5minutes, average less than4minutes. Each ULCs negative patients required inspection time is1-3minutes, average less than2minutes The distribution of group A:21cases of acute myocardial infarction(40.38%),11cases of bacterial pneumonia(21.15%),10cases of acute myocarditis(19.23%),2cases of cardiactamponade(3.85%),1case of dilated cardiomyopathy(1.92%),l case of hypertrophic obstructive cardiomyopathy(1.92%),2cases of peripartum cardiomyopathy(3.85%),3cases of ARDS(5.77%),1case of dissection of aorta(1.92%).B3line was seen in10cases of acute myocardial infarction(32.26%),2cases of cardiactamponade(6.45%),4cases of acute myocarditis(12.9%),l case of peripartum cardiomyopathy(3.23%),11cases of pneumonia(35.48%) and3cases of ARDS(9.68%);B7line was seen in11cases of acute myocardial infarction(52.38%),6cases of acute myocarditis(28.57%),1case of peripartum cardiomyopathy(4.76%),1case of dilated cardiomyopathy(4.76%),1case of hypertrophic obstructive cardiomyopathy(4.76%) and1case of dissection of aorta. The distribution of group B:13cases of acute exacerbation of COPD(36.11%),9cases of asthma(25.00%),5cases of COPD(13.89%),4cases of pulmonary embolism(11.11%),3cases of pneumothorax(8.33%) and2cases of hysteria(5.56%).The medianins of ULCs of heart failure patients in group Ⅰ-Ⅳ respectively:group Ⅰ:8.5;group Ⅱ:19;group Ⅲ:25.5;group IV:33,among the four groups had statistical significance (p<0.05).The medianins of NT-proBNP levels of heart failure patients in group Ⅰ-Ⅳ respectively:group Ⅰ:338pg/ml;group Ⅱ:1062pg/ml;group Ⅲ:1981pg/ml;group Ⅳ:3548pg/ml,among the four groups had statistical significance (p<0.05).The LAD in group Ⅰ-Ⅳ respectively:group Ⅰ:(33.90±2.23)mm;group Ⅱ:(32.00±4.00)mm;group Ⅲ:(33.33±3.37)mm;group Ⅳ:(34.64±4.34)mm,among the four groups had no statistical significance (p>0.05).The LVEDD in group Ⅰ-Ⅳ respectively:group Ⅰ:(49.10±5.70)mm;group Ⅱ:(51.00±5.35)mm;group Ⅲ:(49.33±4.79)mm;group Ⅳ:(52.88±4.94)mm, among the four groups had no statistical significance (p>0.05). The EF in group Ⅰ-Ⅳ respectively::group Ⅰ:0.42±0.12;group Ⅱ:0.40±0.25;group Ⅲ:0.38±0.06;group Ⅳ:0.35±0.49,between group Ⅰ and Ⅳ,Ⅱ and Ⅳ had statistical significance (p<0.05),among other groups had no statistical significance (p>0.05). The E/Ea in group Ⅰ-Ⅳ respectively:.group Ⅰ:8.60±4.83;group Ⅱ:9.80±3.12;group Ⅲ:11.93±2.83;group Ⅳ:12.24±3.14,between group Ⅰ and Ⅳ,Ⅱ and Ⅳ had statistical significance (p<0.05),among other groups had no statistical significance (p>0.05).The SPAP in group Ⅰ-Ⅳ respectively:group Ⅰ:(31.50±3.81)mmHg;group Ⅱ:(41.29± 9.27)mmHg;group Ⅲ:(39.67±8.09)mmHg;group IV:(44.53±9.84)mmHg,between group I and IV had statistical significance (p<0.05),among other groups had no statistical significance (p>0.05). The number of ULCs were correlated with the NT-proBNP levels(r=0.516,p<0.05),the value of EF(r=-0.326,p<0.05),the value of E/Ea (r=0.443,p<0.05),and the value of SPAP(r=0.495, p<0.05). The number of ULCs were not correlated with LAD and LVEDD(p>0.05).Conclusions:1. LUS ULCs positive can make a preliminary differential diagnosis of dyspnea. Cardiac dyspnea patients, ARDS patients and patients with pneumonia LUS examination showed obvious ULCs in dyspnea patients.ULCs distribution in the form of:to the cases which cause alveoli and interstitial diffuse lesions,the number of ULCs in lower lung is higher than upper lung,left and right lung distribution has no obvious difference.To the cases which cause localized alveoli and interstitial lesions, ULCs is limited to the lesion, such as pneumonia.2.ULCs negtive has not diagnosis significance of exclusion.ULCs negative show no alveolar and interstitial pulmonary edema or thickening, the latter is the pathological and physiological characteristics of some specific stages of disease development, therefore the positive diagnostic efficacy of ULCs is higher than negative diagnositic efficacy.3. LUS can be used for heart function of patients in cardiovascular evaluation. For patients with cardiovascular disease, the number of ULCs and NYHA cardiac functional grading level,NT-proBNP, E/Ea,SPAP positive correlation,and EF negtive correlation.4. LUS required for a short time, test results promptly available;the operation is relatively simple and image is simple and easy to understand, so it is very suitable for emergency and ICU on dyspnea preliminary differential diagnosis and cardiac function evaluation. |
PDF Full Text Request