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重症超声在病毒性肺炎患者循环障碍中的应用思考——基于重症超声的新分型与精准治疗

秦瑶 尹万红 曾学英 王洁 朱尧 中国重症超声研究组 

秦瑶, 尹万红, 曾学英, 等. 重症超声在病毒性肺炎患者循环障碍中的应用思考——基于重症超声的新分型与精准治疗[J]. 四川大学学报(医学版), 2021, 52(4): 555-560. doi: 10.12182/20210360502
引用本文: 秦瑶, 尹万红, 曾学英, 等. 重症超声在病毒性肺炎患者循环障碍中的应用思考——基于重症超声的新分型与精准治疗[J]. 四川大学学报(医学版), 2021, 52(4): 555-560. doi: 10.12182/20210360502
QIN Yao, YIN Wan-hong, ZENG Xue-ying, et al. Reflections on the Application of Critical Care Ultrasound in Viral Pneumonia Patients with Circulatory Dysfunction—New Classification and Precision Treatment Based on Ciritical Care Ultrasound[J]. JOURNAL OF SICHUAN UNIVERSITY (MEDICAL SCIENCE EDITION), 2021, 52(4): 555-560. doi: 10.12182/20210360502
Citation: QIN Yao, YIN Wan-hong, ZENG Xue-ying, et al. Reflections on the Application of Critical Care Ultrasound in Viral Pneumonia Patients with Circulatory Dysfunction—New Classification and Precision Treatment Based on Ciritical Care Ultrasound[J]. JOURNAL OF SICHUAN UNIVERSITY (MEDICAL SCIENCE EDITION), 2021, 52(4): 555-560. doi: 10.12182/20210360502

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重症超声在病毒性肺炎患者循环障碍中的应用思考——基于重症超声的新分型与精准治疗

doi: 10.12182/20210360502
基金项目: 四川大学华西医院新型冠状病毒科技攻关项目(No. HX-2019-nCoV-045)资助
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    E-mail:yinwanhong@wchscu.cn

Reflections on the Application of Critical Care Ultrasound in Viral Pneumonia Patients with Circulatory Dysfunction—New Classification and Precision Treatment Based on Ciritical Care Ultrasound

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  • 摘要: 病毒是肺部感染的主要病原体之一,易引起大规模流行性病毒性肺炎。重症病毒性肺炎常常会有急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)表现,其表现出的临床症状特殊性,在循环系统尤为明显。重症超声的广泛使用,使我们能够更加深入地认识重症病毒性肺炎的急性循环障碍特征,并加深我们对其他类型感染所致循环障碍的思考。重症病毒肺炎中急性循环障碍并不少见,主要表现为血管受损、容量紊乱和心脏异常,其中心脏异常又可细分为高应激状态、急性右心障碍及弥漫性心脏功能抑制。在前期管理不善等情况下,这些急性循环障碍又可进展为休克,或者直接导致或加重其他脏器功能障碍(如急性肾损伤),加重不良结局。因此,基于重症超声模块化评估进行急性循环障碍分型,将有助于我们推进对急性循环障碍的理解和更深入的研究。
  • 图  1  基于重症超声的急性循环功能障碍分型

    Figure  1.  Classification of acute circulatory dysfunction based on critical care ultrasound

    ↓↓: Severe decreased; ↓: Lower; ↓/↑: Lower or higher; ↑: Higher; RV: Right ventricle; LV: Left ventricle; LVEF: Left ventricular ejection fraction; RVEF: Right ventricular ejection fraction; LA: Left atrium; LAVI: Left atrial volume index; TRmax: Maximum tricuspid regurgitation velocity; MAPSE: Mitral annular plane systolic excursion; TAPSE: Tricuspid annular plane systolic excursion; IVC: Inferior vena cava; UPIS: Ultrasound pulmonary interstitial syndrome; CO: Cardiac output; TTS: Tako-Tsubo syndrome; PH: Pulmonary hypertension; LVOT: Left ventricular outflow tract; SAM sign: Systolic anterior motion sign; SBRI: Snuffbox restrictive index.

    图  2  病毒性肺炎患者肾脏灌注不足超声表现

    Figure  2.  Ultrasonographic findings of renal hypoperfusion in a patient with viral pneumonia

    A: Blood flow signal was visible at renal hilum, and renal blood perfusion semi-quantitative score was grade Ⅰ; B: Increased renal interlobar artery resistance index.

    图  3  病毒性肺炎患者急性肺心病的超声表现

    Figure  3.  Ultrasonographic findings of acute cor pulmonale in patients with viral pneumonia

    A: Apical four-chamber view with a marked enlargement of the right heart; B: TAPSE 1.41 cm, suggesting right ventricular systolic insufficiency; C: Dilated and fixed inferior vena cava, suggesting obstruction of IVC return and increased right ventricular pressure.

    图  4  病毒性肺炎左心舒张功能不全患者超声表现

    Figure  4.  Ultrasonographic findings of viral pneumonia patients with left ventricular diastolic dysfunction

    A: Apical four-chamber view with left atrium enlarged; B: Anterior mitral valve flow is unimodal.

    图  5  下腔静脉充盈固定,提示容量过负荷

    Figure  5.  Dilated and fixed Inferior vena cava , suggesting hypervolemia

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出版历程
  • 收稿日期:  2020-04-14
  • 修回日期:  2020-12-17
  • 刊出日期:  2021-07-22

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