肺脏超声对新生儿呼吸窘迫综合征和暂时性呼吸增快的临床诊断评价  

Diagnostic evaluation of lung ultrasonography on neonatal respiratory distress syndrome and transient tachypnea

作　　者：王成虎[1] 赵媛[1] 关函洲[1] 王秋平[2] 张宏[3] 张新华[1] Wang Chenghu;Zhao Yuan;Guan Hanzhou;Wang Qiuping;Zhang Hong;Zhang Xinhua(Department of Neonatal Medicine,Shanxi Provincial Children′s Hospital,Taiyuan 030006,China)

机构地区：[1]山西省儿童医院新生儿内科,太原030006 [2]山西省儿童医院超声科,太原030006 [3]山西省儿童医院放射科,太原030006

出　　处：《中国药物与临床》2020年第15期2487-2489,共3页Chinese Remedies & Clinics

基　　金：山西省儿童医院院内基金(201828)。

摘　　要：目的探讨肺脏超声对新生儿呼吸窘迫综合征(RDS)和新生儿暂时性呼吸增快(TTN)的诊断价值。方法采用前瞻性单盲研究方法,收集本院新生儿科临床表现为呼吸窘迫患儿,符合纳入标准患儿进行肺脏超声、胸部X线及临床综合诊断。结果2018年9月至2019年6月,符合纳入标准患儿120例,综合诊断为RDS 33例,TTN 63例,其他疾病24例。综合诊断为RDS 33例患儿中,肺脏超声检查29例符合超声诊断,符合率88%;胸部X线检查17例符合X线诊断,符合率52%。综合诊断为TTN 63例,肺脏超声检查有52例符合超声诊断,符合率83%;胸部X线检查有30例符合X线诊断,符合率48%。肺脏超声检查诊断RDS的敏感度87.9%,特异度94.3%,阳性预测值85.3%,阴性预测值95.3%;诊断TTN的敏感度82.5%,特异度94.7%,阳性预测值94.5%,阴性预测值83.1%。胸部X线检查诊断RDS的敏感度51.1%,特异度79.3%,阳性预测值48.6%,阴性预测值81.1%;诊断TTN的敏感度47.6%,特异度84.2%,阳性预测值76.9%,阴性预测值59.2%。肺超声诊断RDS和TTN的Kappa值分别为0.814和0.768,胸部X线诊断RDS和TTN的Kappa值分别为0.303和0.312,肺超声诊断RDS和TTN的Kappa值均大于胸部X线诊断技术。肺脏超声诊断RDS的受试者工作特征(ROC)曲线下面积(AUC)大于胸部X线影像结果(0.911与0.654,P<0.05),肺脏超声诊断TTN的ROC的AUC大于胸部X线影像结果(0.886与0.659,P<0.05)。结论肺脏超声技术在新生儿RDS和TTN的诊断和鉴别诊断中有较高的临床应用价值。Objective To determine the value of lung ultrasound in the diagnosis of neonatal respiratory distress syndrome(RDS)and transient tachypnea(TTN).Methods A prospective and single-blind trial was conducted.The neonates with clinical manifestations of respiratory distress in the Department of Neonatal Medicine of our hospital were included in the study.The neonates who fulfilled the inclusion criteria were given lung ultrasonography,chest X-ray and clinical comprehensive diagnosis.Results A total of 120 neonates admitted to our hospital between September 2018 and June 2019 fulfilled the inclusion criteria.There were 33 cases of RDS,63 of TTN,and 24 of other diseases.Among the 33 neonates diagnosed with RDS,the results of 29 and 17 cases were consistent with the diagnosis of lung ultrasonography and chest X-ray,with a coincidence rate of 88%and 52%,respectively.Among the 33 neonates diagnosed with TTN,the results of 52 and 30 cases were consistent with the diagnosis of lung ultrasonography and chest X-ray,with a coincidence rate of 83%and 48%,respectively.The sensitivity,specificity,positive predictive value and negative predictive value of lung ultrasonography for RDS and TTN were 87.9%vs 82.5%,94.3%vs 94.7%,85.3%vs 94.5%and 95.3%vs 83.1%,respectively.The sensitivity,specificity,positive predictive value and negative predictive value of chest X-ray for RDS and TTN were 51.1%vs 47.6%,79.3%vs 84.2%,48.6%vs 76.9%and 81.1%vs 59.2%,respectively.The Kappa values of lung ultrasonography and chest X-ray for RDS and TTN were 0.814 vs 0.303 and 0.768 vs 0.312,respectively.The Kappa values of lung ultrasonography for RDS and TTN were higher than those of chest X-ray.The area under the ROC curve(AUC)of lung ultrasonography for RDS was greater than that of chest X-ray imaging(0.911 vs 0.654,P<0.05),and the AUC of lung ultrasonography for TTN was greater than that of chest X-ray imaging(0.886 vs 0.659,P<0.05).Conclusion Lung ultrasonography shows high clinical value in the differential diagnosis of neonatal RDS and TTN.

关 键 词：肺脏超声 呼吸窘迫综合征 新生儿 呼吸急促 

分 类 号：R722.1[医药卫生—儿科]