新生儿呼吸窘迫综合征超声诊断与分度多中心前瞻性研究  

Ultrasound diagnosis and grading of neonatal respiratory distress syndrome:a multicenter prospective study

作　　者：刘敬[1] 李洁[2] 单瑞艳 邓碧滢 王英俊[5] 黄荔涵 宗海峰 徐彦磊[8] 孟琼[9] 刘艳 曹海燕 管亚丽 于霞 涂昊 刘女霞 游楚明[9] 袁丽[1] 张丽 刘燕妮 邱如新 Liu Jing;Li Jie;Shan Ruiyan;Deng Biying;Wang Yingjun;Huang Lihan;Zong Haifeng;Xu Yanlei;Meng Qiong;Liu Yan;Cao Haiyan;Guan Yali;Yu Xia;Tu Hao;Liu Nyuxia;You Chuming;Yuan Li;Zhang Li;Liu Yanni;Qiu Ruxin(Department of Neonatology and NICU,Beijing Chaoyang District Maternal and Child Healthcare Hospital,Beijing 100021,China;Department of Neonatology,Zaozhuang Maternal and Child Healthcare Hospital,Zaozhuang 277000,China;Department of Neonatology,the Affiliated Yantai Yuhuangding Hospital of Qingdao University,Yantai 264000,China;Department of Neonatology and NICU,Dongguan Children′s Hospital,Dongguan 523325,China;Neonatal Intensive Care Unit,Zhoukou Central Hospital,Zhoukou 466000,China;Department of Neonatology,Women and Children′s Hospital,School of Medicine,Xiamen University,Xiamen 361002,China;Neonatal Intensive Care Unit,Affiliated Shenzhen Maternity&Child Healthcare Hospital,Southern Medical University,Shenzhen 518028,China;Neonatal Intensive Care Unit,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Pediatrics,Guangdong Second Provincial General Hospital,Guangzhou 510317,China;Department of Ultrasound,Dalian Women′s and Children′s Medical Center,Dalian 116000,China;Department of Pediatrics,the First Hospital of Lanzhou University,Lanzhou 730000,China;Department of Ultrasound Diagnosis,Zhengzhou Maternal and Child Healthcare Hospital,Zhengzhou 450012,China;Department of Ultrasound,Weihai Maternal and Child Healthcare Hospital,Weihai 264200,China;Deparement of Ultrasound,National Hospital of Enshi Tujia and Miao Autonomous Prefecture,Enshi 445000,China;Department of Medical Technology,the First People′s Hospital of Yinchuan,Yinchuan 750000,China;9 Department of Pediatrics,Guangdong Second Provincial General Hospital,Guangzhou 510317,China)

机构地区：[1]北京市朝阳区妇幼保健院新生儿科/NICU,100021 [2]山东省枣庄市妇幼保健院新生儿科,277000 [3]青岛大学医学院附属烟台毓黄顶医院新生儿科,烟台264000 [4]东莞市儿童医院新生儿科/NICU,523325 [5]河南省周口市中心医院新生儿重症监护室,466000 [6]福建省厦门市妇幼保健院新生儿科,361002 [7]南方医科大学附属深圳妇幼保健院新生儿科,518028 [8]郑州大学第一附属医院新生儿科一病区,450052 [9]广东省第二人民医院儿科,广州510317 [10]大连市妇女儿童医疗中心超声科,116000 [11]兰州大学第一医院儿科,兰州730000 [12]河南省郑州市妇幼保健院超声诊断科,450012 [13]山东省威海市妇幼保健院超声二科,264200 [14]湖北省恩施土家族苗族自治州民族医学院功能科,恩施445000 [15]宁夏回族自治区银川市第一人民医院医技科,750000

出　　处：《中国小儿急救医学》2020年第11期801-807,共7页Chinese Pediatric Emergency Medicine

基　　金：北京市朝阳区科学技术和信息化局社会发展基金资助项目(CYSF1922)。

摘　　要：目的肺脏超声(lung ultrasound,LUS)已经成功用于新生儿呼吸窘迫综合征(respiratory distress syndrome,RDS)的诊断,但尚缺乏多中心、前瞻性研究予以验证,也没有关于RDS超声分度的研究报告。本研究将通过对RDS超声诊断的多中心前瞻性研究,探讨对RDS进行超声分度的必要性及不同程度RDS的超声影像学特点。方法所有参与者均参加过全国新生儿肺脏超声培训班,并在全国新生儿肺脏超声培训基地接受为期3~6个月的肺脏超声系统培训。在2018年6月至2020年5月期间符合RDS超声诊断标准、资料完整的病例纳入本研究。患儿入院后即刻完成LUS检查,部分患儿同时接受胸部X线检查,在LUS检查前或后立即完成动脉血气分析。根据LUS表现、患儿有无严重并发症对RDS进行分度。结果研究期间共收集合格病例275例。其中早产儿220例、足月儿55例;原发性RDS 117例(42.5%)、继发性RDS 158例(57.5%)。RDS患儿的LUS表现分为3种:(1)磨玻璃征样肺实变:50例患儿入院时(首次)LUS表现为磨玻璃征;其中28例被认为系湿肺、未予特殊处置,复查LUS在0.5~4 h内出现典型雪花征样肺实变;22例给予机械通气和补充外源性肺表面活性物质治疗者,18例病情在6~12 h内控制,4例(严重宫内感染所致)肺部病变继续发展、复查LUS呈现典型雪花征样肺实变且累及范围扩大。(2)雪花征样肺实变:204例患儿入院时LUS表现为雪花征样肺实变,其中38例患儿程度稍轻:肺实变仅累及1~2个肋间隙,其中15例予有创呼吸支持者均在4~12 h恢复;12例予无创呼吸支持者,7例恢复好转、5例发展至重症;另外11例未给予任何形式呼吸支持治疗者在1~4 h内发展至重症。30例患儿肺实变程度较重,入院时雪花征已累及12个肺分区。其余136例患儿肺实变程度介于上述二者之间。(3)雪花征样肺实变伴并发症形成:21例患儿虽然雪花征样肺实变没有累及所有肺分区,但已引起�Objective Lung ultrasound(LUS)has been used in the diagnosis of neonatal respiratory distress syndrome(RDS)successfully,but there have been no multicenter prospective studies to verify its reliability or determine how to grade RDS with LUS findings.This study aimed to discuss the necessity and feasibility of using LUS findings to determine RDS grades through a multicenter prospective study.Methods Every researcher participated in the National Neonatal Lung Ultrasound Training Course and receiving 3-6 months of lung ultrasound system training at the National Neonatal Lung Ultrasound Training Center.Patients between June 2018 and May 2020 who met the RDS ultrasound diagnostic criteria and had full available clinical data were included in this study.The LUS examination was completed immediately after the patients were admitted to the hospital.Some of them also underwent chest X-ray examination.Arterial blood gas analysis was completed immediately before or after the LUS ultrasound examination.RDS grading was performed according to the LUS findings and whether the patient had serious complications.Results A total of 275 qualifying cases were included in this study,which included 220 premature infants and 55 full-term infants,and the primary RDS occurred in 117 cases(42.5%),and secondary RDS occurred in 158 cases(57.5%).LUS manifestations of RDS patients can be divided into three categories:(1)A ground-glass opacity sign:which could be found among 50 infants when they were admitted to the hospital(that was,at their first LUS examination).Twenty-eight of these infants were considered to have wet lungs and were not sent for special management on admission,but LUS showed typical snowflake-like lung consolidation within 0.5 to 4 hours.Twenty-two of them were given mechanical ventilation with exogenous pulmonary surfactant;Eighteen cases were controlled within 6-12 hours,but the lung lesions became more severe in the other 4 infants(due to severe intrauterine infection).(2)Snowflake-like lung consolidations:the first LUS o

关 键 词：呼吸窘迫综合征 肺脏超声 超声诊断 超声分度 多中心研究 婴儿 新生 

分 类 号：R722.1[医药卫生—儿科] R445.1[医药卫生—临床医学]