肺部超声和临床评估在新生儿突发性气胸诊断中的价值  

Value of lung ultrasound and clinical evaluation in the diagnosis of neonates with sudden pneumothorax

作　　者：牛慧敏[1] 徐丽瑾[2] 高洁[1] 于明月[1] 薛红元[1] NIU Hui-min;XU Li-jin;GAO Jie;YU Ming-yue;XUE Hong-yuan(Department of Ultrasound, Hebei General Hospital, Shijiazhuang, Hebei 050051, China)

机构地区：[1]河北省人民医院超声科,河北石家庄050051 [2]河北省人民医院儿科,河北石家庄050051

出　　处：《临床肺科杂志》2018年第6期1077-1081,共5页Journal of Clinical Pulmonary Medicine

基　　金：河北省卫计委重点课题(No 20170344)

摘　　要：目的新生儿突发性气胸是新生儿常见的危急重症,通过对比肺部超声(LUS)和胸部X线(CXR)与胸部透射(CTR)对气胸的诊断敏感性和特异性,确定肺部超声对新生儿突发性气胸的诊断价值。同时通过对各项临床评估建立回归模型,确定各项临床评估在诊断新生儿突发性气胸的价值。方法回顾分析我院2015年至2017年120例接受肺部超声、胸部X线和胸部透射三种检查的突发性气胸新生儿,同时随机抽取同时间段120例接受肺部超声、胸部X线和胸部透射三种检查的非气胸性呼吸困难的新生儿作为对照组。以胸部X线为金标准,计算三种检查方法的敏感性、特异性和诊断准确率。同时收集两组患儿的各项临床指标,通过建立Logistics回归分析,确定各项临床指标对新生儿突发性气胸的诊断价值。结果 LUS的敏感性、特异性、诊断准确性分别为1、0.98、0.99,比CTR高(P<0.05)与金标准CXR无统计学差异。(P=0.23)。根据Logistics回归分析,新生儿的胎龄和出生体重与新生儿突发性气胸呈负相关,胎龄越大、出生体重越重发生新生儿突发性气胸的概率越小,而胎膜早破、肺透明膜疾病、胎粪吸入、产妇糖尿病、产妇妊高症是新生儿突发性气胸的危险因素。结论 LUS对新生儿突发性气胸诊断有较高的敏感性和特异性及诊断准确率。与新生儿和孕妇的相关临床评估可应用于预测新生儿突发性气胸。Objective To assess the diagnostic value of lung ultrasonography（ LUS） and clinical evaluation of the diagnosis of neonates with sudden pneumothorax by comparing the sensitivity and specificity of LUS,CXR and CTR on pneumothorax and establishing the regression model of clinical evaluation. Methods The clinical data of120 neonates with pneumothorax,all of whom received chest X-ray（ CXR）,chest transillumination（ CTR） and LUS,were retrospectively analyzed. At the same time,another 120 newborns without pneumothorax who underwent lung ultrasonography,chest X-ray and were selected as the control group. Taking CXR as the gold standard,the sensitivity,specificity and diagnostic accuracy of the three methods were calculated. Logistics regression analysis was used to determine whether the clinical indicators were risk factors of pneumothorax. Results The sensitivity,specificity,diagnostic accuracy of LUS were higher than CTR（ P〈0. 05）,but had no statistical difference with CXR.According to logistic regression analysis,small gestational age and low body weight,premature rupture of membranes,hyaline membrane disease,meconium aspiration,maternal diabetes mellitus,maternal pregnancy-induced hypertension were risk factors for neonatal sudden pneumothorax. Conclusion LUS has a high sensitivity and specificity and diagnostic accuracy for neonatal sudden pneumothorax diagnosis. The clinical assessment associated with neonatal and pregnant can be used to predict neonatal sudden pneumothorax.

关 键 词：新生儿 突发性气胸 肺部超声 胸部X线 临床评估 

分 类 号：R445.1[医药卫生—影像医学与核医学] R722.1[医药卫生—诊断学]