肺脏超声对新生儿肺不张的诊断价值  

Lung ultrasound for diagnosis of neonatal atelectasis

作　　者：刘敬[1] 刘颖[1] 王华伟[1] 李静雅[1] 韩涛[1] 梁婧[1] 杨常栓[1] 邢蒙[1] 封志纯[1] 

机构地区：[1]北京军区总医院附属八一儿童医院新生儿重症监护中心,100700

出　　处：《中华儿科杂志》2013年第9期644-648,共5页Chinese Journal of Pediatrics

基　　金：中国博士后科学基金特别资助金（200801041）;中国博士后科学基金二等资助金（20080431405）

摘　　要：目的研究新生儿肺不张（NA）的超声影像学特点及肺脏超声对NA的诊断价值。方法2012年5月-2013年6月在北京军区总医院附属八一儿童医院新生儿重症监护中心住院、经胸部x线或CT检查确诊为肺不张的40例患儿作为观察组，同时行肺部超声检查；同期住院的40例非肺病患儿为对照组。肺部超声检查在安静状态下进行，患儿取仰卧、侧卧或俯卧位，以腋前线、腋后线为界，将肺脏分成前、侧、后三个区域，超声探头与肋骨垂直或平行，分别对双侧肺脏的每个区域进行扫查。将超声检查结果与传统胸部x线或CT检查结果作对照。结果（1）NA的超声影像学征象主要包括肺实变伴支气管充气征、胸膜线异常、A线消失等，实时超声下可见肺搏动及肺滑消失。（2）40例患儿肺脏超声检查均有阳性发现，敏感性为100％；但胸部x线检查有阳性者发现仅28例，即敏感性仅70％；其余12例经胸部cT检查证实。结论超声诊断NA准确可靠，其敏感性优于传统胸部x线检查；且具有简便、无创、可在床边开展、可随时检测、可避免射线损伤等优点，对指导治疗及病情观察具有重要价值。Objective The diagnosis of neonatal atelectasis （NA） is usually based on clinical manifestations and chest X-rays, lung ultrasounds are not included in the diagnostic work-up of NA. Recently, ultrasounds have been used extensively and successfully in the diagnosis of many kinds of lung diseases, but few studies have addressed NA. The aim of this study was to evaluate the ultrasound imaging features of NA-and to evaluate the value of lung ultrasound in diagnosing NA. Method From May, 2012 to June ,2013, 40 newborn infants with NA and another 40 neonates without lung disease were enrolled into this study. Lung ultrasound was performed at the bedside by a single expert physician. In a quiet state, the infants were positioned in supine, side or prone postures. The lung field was divided into three areas by the anterior axilary and posterior axilary line. The regions of the bilateral lungs were scaned by the probe which was vertical or parallel with the ribs, then compared the results with conventional chest X-ray findings. Result （ 1 ） The main ultrasound imaging features of neonatal NA include lung consolidation with air bronchograms, pleural line abnormalities and A-line disappearance. Besides, lung pulse and lung sliding disappearance could be seen by real-time ultrasound. （2） The sensitivity of lung ultrasound for diagnosis of NA was 100%, while it was only 70% for conventional chest X-rays. Conclusion Use of ultrasound to diagnose NA is accurate and reliable, the sensitivity was superior to that of conventional chest X-ray examination, which also has many other advantages including easy-operating, non-ionizing, can be performed at the bedside, therefore, ultrasonic can provide important value for clinicians.

关 键 词：肺脏超声 肺不张 婴儿 新生 

分 类 号：R722.1[医药卫生—儿科]