nmpЖурнал им. Н.В. Склифосовского «Неотложная медицинская помощь»Russian Sklifosovsky Journal "Emergency Medical Care"2223-90222541-8017“N.V. Sklifosovsky Research Institute for Emergency Medicine”10.23934/2223-9022-2022-11-4-645-654nmp-1521Research ArticleОБЗОР ЛИТЕРАТУРЫREVIEWSРоль ультразвука в диагностике внебольничной пневмонииThe Role of Ultrasound in Diagnosing Community-Acquired Pneumoniahttps://orcid.org/0000-0002-5069-6080СтаростинД. О.StarostinD. O.

Старостин Даниил Олегович, ассистент кафедры анестезиологии и реаниматологии

107031, Москва, ул. Петровка, д. 25, стр. 2

Daniil O. Starostin, Assistant of the Department of Anesthesiology and Resuscitation, Institute of Higher and Additional Professional Education

25-2, Petrovka Str., Moscow, 107031

starostin_daniil@mail.ruhttps://orcid.org/0000-0002-5930-0118КузовлевА. Н.KuzovlevA. N.

Кузовлев Артём Николаевич, доктор медицинских наук, профессор, заместитель директора – руководитель

107031, Москва, ул. Петровка, д. 25, стр. 2

 

Artyom N. Kuzovlev, Doctor of Medical Sciences, Professor, Deputy Director – Head

25-2, Petrovka Str., Moscow, 107031

artem_kuzovlev@mail.ruФГБНУ «Федерального научно-клинического центра реаниматологии и реабилитологии», НИИ общей реаниматологии им. В.А. НеговскогоРоссияV.A. Negovsky Research Institute of General Resuscitation of the Federal Research and Clinical Center of Resuscitation and RehabilitationRussian Federation202202022023114645654Copyright © Старостин Д.О., Кузовлев А.Н., 20232023Старостин Д.О., Кузовлев А.Н.Starostin D.O., Kuzovlev A.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jnmp.ru/jour/article/view/1521

АКТУАЛЬНОСТЬ Обзор литературы посвящен актуальной проблеме — диагностике пневмонии с помощью ультразвука. В обзоре описаны методические основы данного метода, его преимущества и недостатки, чувствительность и специфичность для диагностики тяжелой внебольничной пневмонии в практике врача анестезиолога-реаниматолога.

ЦЕЛЬ Анализ информативности ультразвукового исследования (УЗИ) легких при внебольничной пневмонии в современной отечественной и зарубежной доказательной базе врача анестезиологареаниматолога.

МАТЕРИАЛ И МЕТОДЫ Поиск отечественных публикаций проводили в базе данных eLibrary.ru, зарубежных — в базе данных PubMed. Был проведен поиск по публикациям (обзоры литературы, обсервационные исследования, двойные слепые рандомизированные исследования) за период 2010–2020 гг. Первично было выбрано 1379 публикаций, идентифицированных через поиск баз данных. После удаления повторов количество публикаций сократилось до 695. Из этого числа исключили 503 публикации. Оставшиеся 192 полнотекстовые статьи оценивались на приемлемость текста. По причине несоответствия основным разделам обзора из них было удалено 77 статей. Остальные 115 были включены в качественный синтез и 67 избраны в количественный синтез.

РЕЗУЛЬТАТЫ Ультразвук является многообещающей и достойной альтернативой другим методам лучевой диагностики. По результатам анализа рентгенография органов грудной клетки (Rg ОГК) уступила УЗИ легких в диагностике наличия жидкости в плевральных полостях. Чувствительность УЗИ при оценке плеврального выпота достигает 100%, специфичность — 99,7%. УЗИ легких играет важную роль в диагностике пневмонии и является многообещающей привлекательной альтернативой Rg ОГК и компьютерной томографии ОГК.

ОБСУЖДЕНИЕ Поскольку УЗИ в месте оказания медицинской помощи (POCUS) выполняется у постели больного, результаты доступны врачу в режиме реального времени, что помогает в диагностике и выборе тактики лечения. Последовательные серии УЗИ могут быть выполнены для мониторинга динамики заболевания и реакции на лечение. Однако во многих учреждениях нет возможности сохранять УЗ-изображения, поэтому другие медицинские работники не могут их видеть.

ВЫВОДЫ Ультразвуковое исследование легких вряд ли сможет заменить компьютерную томографию органов грудной клетки, так как не обладает 100% специфичностью, однако оно незаменимо в прикроватном исследовании и является сонографическим «стетоскопом» врача, который значительно расширяет диагностические возможности.

BACKGROUND The literature review is devoted to an urgent problem of the diagnosis of pneumonia in the practice of an anesthesiologist-resuscitator using ultrasound. The literature review describes the methodological foundations of this method, its advantages and disadvantages, sensitivity and specificity for the diagnosis of severe community-acquired pneumonia in the practice of an anesthesiologist-resuscitator.

AIM OF STUDY The analysis of the most modern domestic and foreign evidence base based on the information content of lung ultrasound in CAP in the practice of an anesthesiologist-resuscitator.

MATERIAL AND METHODS Russian publications were searched in the elibrary.ru database, foreign publications were searched in the PubMed database. Publications (literature reviews, observational studies, double-blind randomized trials) were searched for the period 2010–2020. A total of 1379 publications were initially selected, identified through database searches. After removing duplicates, the number of publications was reduced to 695. Of this number, 503 publications were excluded. The remaining 192 full-text articles were evaluated for text acceptability. Due to inconsistency with the main sections of the review, 77 articles were deleted from them. The remaining 115 ones were included in the qualitative synthesis and 67 ones were selected in the quantitative synthesis.

RESULTS The ultrasound is a promising and worthy alternative to other imaging modalities. According to the results chest X-ray was inferior to lung ultrasound in diagnosing the presence of fluid in the pleural cavities. The sensitivity of ultrasound in assessing pleural effusion reaches 100%, the specificity is 99.7%. Pulmonary ultrasonography plays an important role in the diagnosis of pneumonia and is a promising alternative to chest X-ray and chest CT.

DISCUSSION Since POCUS is performed at the patient’s bedside, the results are available to the doctor in real time, which helps in diagnosis and treatment. Sequential examinations can be performed to monitor disease progression and response to treatment. However, many facilities do not have the ability to store ultrasound images, so other healthcare professionals cannot see them.

FINDINGS The ultrasound examination of the lungs is unlikely to replace computed tomography of the chest, as it does not have 100% specificity, however, it is indispensable in bedside examination and is the doctor’s sonographic “stethoscope”, which significantly expands diagnostic capabilities.

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The authors declare that there are no conflicts of interest present.