肺超声诊断早产儿呼吸窘迫综合征的临床价值  

Application value of lung ultrasound in the diagnosis of respiratory distress syndrome in premature infants

作　　者：郑磊 王廉一 刘丽红[1] 徐小静[2] 武文艳[2] 郭瑞君[3] ZHENG Lei;WANG Lianyi;LIU Lihong;XU Xiaojing;WU Wenyan;GUO Ruijun(Department of Ultrasound,the First Affiliated Hospital of Tsinghua University,Beijing 100016,China)

机构地区：[1]北京华信医院清华大学第一附属医院超声科,北京市100016 [2]北京华信医院清华大学第一附属医院儿科,北京市100016 [3]首都医科大学附属北京朝阳医院超声医学科

出　　处：《临床超声医学杂志》2021年第3期195-198,共4页Journal of Clinical Ultrasound in Medicine

摘　　要：目的分析早产儿呼吸窘迫综合征(NRDS)的肺超声表现,探讨不同肺超声表现诊断NRDS的临床应用价值。方法选取我院收治的疑诊NRDS早产儿109例,于使用外源性肺表面活性物质和持续气道正压通气或常规机械通气治疗前行肺超声检查,同时进行血气分析和胸部X线检查。以临床诊断结果为标准,根据不同肺超声表现制定A、B、C三种诊断标准(胸膜线增厚,至少一个肺野内出现“B”线或“AIS”征为A标准;胸膜线增厚,出现“白肺”征,“A线”征消失为B标准;胸膜线增厚,出现“白肺”征且任一肺野可见“肺实变”征为C标准),分析其对早产儿NRDS的诊断效能。结果109例NRDS早产儿中,临床诊断NRDS 31例,非NRDS 78例。A标准对NRDS的诊断敏感性和阴性预测值均为100%,B标准的诊断敏感性和阴性预测值均高于C标准(70.96%vs.38.71%,89.66%vs.80.41%,均P<0.05)。31例NRDS中,重症NRDS 15例,非重症NRDS 16例。C标准诊断重症NRDS的敏感性、特异性、阳性预测值、阴性预测值分别为73.33%、93.75%、91.66%、78.94%,AUC为0.835,与临床诊断的一致性Kappa值为0.676。结论“白肺”征是肺超声早期诊断早产儿NRDS的重要影像学特征;“白肺”征合并“肺实变”可初步诊断早产儿重症NRDS。Objective To analyze the lung ultrasonographic findings of respiratory distress syndrome(NRDS)in premature infants,and to explore the clinical value of different lung ultrasonographic findings in the diagnosis of NRDS.Methods A total of 109 preterm infants with suspected NRDS were selected from our hospital.Before treatment with exogenous pulmonary surfactant,continuous positive airway pressure or conventional mechanical ventilation,lung ultrasound examination,blood gas analysis and chest X-ray examination were performed.According to the clinical diagnosis results as the standard,different diagnostic criteria were established according to different lung ultrasonic manifestations(pleural line thickened,“B line”sign or“AIS”sign in at least one lung field was standard A,pleural line thickened,“white lung”sign appeared,“A line”sign disappeared was standard B,pleural line thickened,“white lung”sign and“lung onsolidation”sign visible in any lung field was standard C),and their diagnostic efficacy for NRDS in premature infants were analyzed.Results Among the 109 NRDS preterm infants,31 cases were diagnosed as NRDS and 78 cases were not diagnosed as NRDS.The diagnostic sensitivity and negative predictive values of standard A for NRDS were both 100%,and those of standard B were higher than those of standard C(70.96%vs.38.71%,89.66%vs.80.41%,both P<0.05).Among the 31 NRDS cases,15 cases were severe NRDS and 16 cases were non-severe NRDS.The sensitivity,specificity,positive predictive value and negative predictive value of standard C for the diagnosis of severe NRDS were 73.33%,93.75%,91.66%and 78.94%,respectively,and the Kappa value and AUC were 0.676 and 0.835.Conclusion“White lung”sign is an important imaging feature of lung ultrasound in early diagnosis of NRDS in premature infants“.White lung”sign combined with“Lung consolidation”sign can be initially diagnosed as severe NRDS in premature infants.

关 键 词：超声检查 肺 呼吸窘迫综合征 早产儿 诊断价值 

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]