双肺12区超声评分法对新生儿呼吸窘迫综合征诊断及病情评估的价值  

The value of double lung 12 areas ultrasound score in the diagnosis and evaluation of neonatal respiratory distress syndrome

作　　者：朱凌波 王晓倩 周绍斌[2] 龚心琰[1] ZHU Lingbo;WANG Xiaoqian;ZHOU shaobin;GONG xinyan(Department of Internal Medicine,Yiwu Central Hospital,Zhejiang Yiwu 322000,China;Department of Radiology,Jinhua Central Hospital,Zhejiang Jinhua 321000,China)

机构地区：[1]义乌市中心医院内科,浙江义乌322000 [2]金华市中心医院放射科,浙江金华321000

出　　处：《中国妇幼健康研究》2020年第4期436-440,共5页Chinese Journal of Woman and Child Health Research

基　　金：金华市科学技术研究计划项目(编号:19-4-136)。

摘　　要：目的探讨双肺12区超声评分法对新生儿呼吸窘迫综合征(NRDS)临床诊断及病情评估的应用价值。方法将2017年6月至2019年7月期间在本院新生儿重症监护室住院的65例NRDS患儿和同期收治的50例非肺病新生儿,采用前瞻性研究方法入组,分别为NRDS组和对照组。两组新生儿均接受肺超声检查,观察NRDS患儿的超声征象,并进行经腹肺超声分级和双肺12区域肺超声评分,与X线分级下的NRDS新生儿双肺征象进行比较,采用Spearman法分析其相关性,借助受试者工作特征(ROC)曲线分析双肺12区域肺超声评分评估不同病情程度的最佳截断点(Cut-off),并计算灵敏度、特异度和曲线下面积(AUC)。结果经腹肺超声分级Ⅰ级20例,Ⅱ级26例,Ⅲ级19例。X线分级Ⅰ级23例,Ⅱ级19例,Ⅲ级16例,Ⅳ级7例。NRDS新生儿经腹超声和X线分级呈正相关(r=0.652,P<0.05)。X线分级中Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级双肺12区肺超声评分分别为(32.97±5.90)分、(24.39±5.48)分、(18.95±4.27)分、(12.18±3.29)分。X线不同分级的双肺12区与超声评分比较,差异有统计学意义(F=35.287,P<0.05)。NRDS新生儿双肺12区超声评分与X线分级呈显著负相关(r=-0.803,P<0.05)。根据X线分级将65例NRDS组分为轻度(Ⅰ级,n=23)、中度(Ⅱ~Ⅲ级,n=35)和重度(Ⅳ级,n=7)3个亚组,ROC曲线分析显示:双肺12区超声评分评估轻度和中度NRDS、中度和重度NRDS的Cut-off分别为27.58分、14.70分,灵敏度分别为91.11%、92.00%,特异度分别为84.00%、95.55%,AUC分别为0.832、0.897。结论双肺12区超声评分是临床诊断新生儿NRDS和定量评估病情程度的有效方法,值得深入研究和临床应用。Objective To explore the application value of double lung 12 areas ultrasound score in the clinical diagnosis and evaluation of neonatal respiratory distress syndrome(NRDS).Methods 65 cases of infants with NRDS hospitalized in the neonatal intensive care unit of Yiwu Central Hospital from June 2017 to July 2019 and 50 cases infants without pulmonary diseases admitted during the same period were enrolled in the NRDS group and the control group by prospective study method,respectively.Both groups received lung ultrasound examination to observe the ultrasonic signs of NRDS infants and performed transabdominal lung ultrasound score and double lung 12 areas ultrasound score,and compared with the double lung signs of NRDS neonates under X-ray grading.The Spearman method was used to analyze the correlation between transabdominal lung ultrasound grading,double lung ultrasound 12 areas score and X-ray grading of NRDS neonates.The optimal cut-off point(Cut-off) of different severity was evaluated by using the receiver operating characteristic(ROC) curve,and the sensitivity,specificity and areas under the curve(AUC) were calculated.Results Transabdominal lung ultrasound grade Ⅰ included 20 cases,grade Ⅱ included 26 cases,and grade Ⅲ included 19 cases.X-ray grade Ⅰ included 23 cases,grade Ⅱ included 19 cases,grade Ⅲ included 16 cases,and grade Ⅳ included 7 cases.The NRDS neonatal transabdominal ultrasound was positively correlated with X-ray grade(r=0.652,P<0.05).In the X-ray grading,grade Ⅰ,grade Ⅱ,grade Ⅲ and grade Ⅳ,the double lung ultrasound scores of the 12 areas were(32.97±5.90) points,(24.39±5.48) points,(18.95±4.27) points and(12.18±3.29) points,respectively.The difference of double lung 12 areas ultrasonic score between different X-ray grading was statistically significant(F=35.287,P<0.05).There was a significant negative correlation between double lung 12 areas ultrasound score and X-ray grading(r=-0.803,P<0.05).According to the X-ray grading,65 cases of NRDS were divided into three subgro

关 键 词：新生儿呼吸窘迫综合征 双肺12区超声评分法 诊断 病情程度 

分 类 号：R722.1[医药卫生—儿科]