中文摘要：

目的探讨床旁超声在呼吸机相关性肺炎（VAP）诊断中的价值。方法应用便携式超声诊断仪对2013年1月至2015年2月在解放军总医院及海南分院重症监护室住院,临床疑诊呼吸机相关性肺炎并行气管插管48 h以上的82例患者进行床旁超声检查及CT扫查,与临床治愈最终诊断结果对照,总结呼吸机相关性肺炎患者床旁超声声像图特征。结果 82例临床疑诊呼吸机相关性肺炎的患者低频超声显示肺实变区内可见气管和支气管回声16例（19.5%,16/82）、局部或广泛出现3条以上B线56例（68.3%,56/82）;高频超声显示病变处正常胸膜线模糊不清72例（87.8%,72/82）,脏壁层胸膜增厚呈不均质低回声。CT扫查显示肺内密度增高影内可见充气支气管征15例（18.3%,15/82）,肺内絮状高密度影或磨玻璃影59例（72.0%,59/82）。结合床旁超声和CT检查结果临床最终诊断呼吸机相关性肺炎并治愈75例,其余7例为心力衰竭、肺不张和和肺梗死。与临床最终诊断结果对照,床旁超声正确诊断呼吸机相关性肺炎72例（96.0%,72/75）,未诊断3例（4.0%,3/75）;CT正确诊断呼吸机相关性肺炎74例（98.7%,74/75）,未诊断3例（4.0%,3/75）。结论床旁超声诊断呼吸机相关性肺炎具有实时、便捷,准确性较高的特点,可作为呼吸机相关性肺炎诊断中的重要影像学方法。

英文摘要：

Objective To evaluate the diagnostic value of bedside ultrasound in ventilator-associated pneumonia（VAP）. Methods Eighty-two patients who were hospitalized in our intensive care unit（ICU） from January 2013 to February 2015 were enrolled in this study. All patients were suspected with VAP after tracheal intubation for more than 48 hours. Portable ultrasound device was used for evaluating parietal pleura, thoracic cavity and visceral pleura at bedside. Ultrasound imaging features were analyzed and its findings were compared with those of CT and final clinical outcomes. Results Eighty-two patients who were suspected with VAP for ultrasound, the low frequency ultrasound showed tracheal and bronchial areas of consolidation of the lung in 16 cases（19.5%, 16/82）, partial or lung widely more than 3 B lines in 56 cases（68.3%, 56/82）; The high frequency ultrasound displayed smooth and neat pleural line disappeared, a thickening, heterogenous and hypoechoic region with texture confusion which consisted of parietal pleura, thoracic cavity and visceral pleura in 72 cases（87.8%, 72/82）. CT scan demonstrates a high-density lesion air bronchogram in lung lobe in 15 cases（18.3%, 15/85）; the lungs flocculent high-density shadow or ground-glass opacities in 59 cases（72.0%, 59/82）. Final clinical outcomes showed that 75 of 82 patients with suspected VAP were diagnosed as VAP. The other 7 cases were atelectasis, pulmonary infarction, heart failure. In comparison with clinical final outcomes, ultrasound diagnosed VAP accurately in 72 cases（96.0%, 72/75）, 3 cases were misdiagnosed（4.0%, 3/75） by ultrasound. CT diagnosed 74 cases（98.7%, 74/75） of VAP, 3 cases（4.0%, 3/75） weve misdiagnosed. Conclusion Bedside ultrasound is real-time, convenient and accurate, and can be used as an important imaging diagnostic method of VAP.