肺部超声检查在新生儿呼吸窘迫综合征诊断和疗效评估中的应用价值  

The application of the lung ultrasound in the diagnosis and evaluation of therapeutic effects of neonatal respiratory distress syndrome

作　　者：房晓祎 郭晓容 李管明 林瀚妮 张霭润 翁立坚[2] 林霓阳[2] Fang Xiaoyi;Guo Xiaorong;Li Guanming;Lin Hanni;Zhang Airun;Weng Lijian;Lin Niyang(Department of Neonatology,Seventh Affiliated Hospital,Sun Yat-sen University,Shenzhen 518107,China;Department of Neonatology,First Affiliated Hospital,Shantou University Medical College,Shantou 515041,China)

机构地区：[1]中山大学附属第七医院新生儿科,深圳518107 [2]汕头大学医学院第一附属医院新生儿科,515041

出　　处：《中华新生儿科杂志（中英文）》2021年第1期40-45,共6页Chinese Journal of Neonatology

基　　金：2019广东省研究生教育创新计划(2019JGXM05);2020年深圳“医疗卫生三名工程”项目(SZSM202011004);2019年广东省卫生健康适宜技术推广项目(粤卫办科教函[2019]7号)。

摘　　要：目的探讨肺部超声在新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,RDS)诊断及疗效评估中的应用价值。方法本研究为回顾性研究,纳入2017年4月至2019年4月汕头大学医学院第一附属医院新生儿重症监护室根据临床表现及胸部X线确诊为RDS的早产儿为RDS组,按1∶1的比例纳入同期无心肺疾病早产儿为对照组,分析RDS患儿肺部超声图像特征,应用SPSS 19.0统计软件对比各级RDS肺部超声图像,分析各级RDS肺部超声图像与胸部X线的相关性,通过肺部超声和胸部X线评估肺表面活性物质的治疗效果。结果 RDS组和对照组分别纳入69例早产儿。RDS患儿肺部超声胸膜线异常、A线异常、出现B线、肺泡间质综合征(alveolar interstitial syndrome,AIS)阳性率均为100%,肺实变及白肺样改变阳性率分别为71.0%和49.3%,胸膜线异常、肺实变及白肺样改变3种征象同时存在诊断RDS的敏感度40.5%、特异度100%、阳性预测值100%、阴性预测值62.7%,胸膜线异常、肺实变、AIS 3种征象同时存在诊断RDS的敏感度71.0%、特异度100%、阳性预测值100%、阴性预测值77.5%。胸部X线RDS分级越高,肺部超声出现肺实变肺分区数目越多(r=0.836,P<0.05),评分越高(r=0.868,P<0.05)。超声评分10分预测Ⅱ级RDS的敏感度80.0%、特异度94.4%,超声评分15分预测Ⅲ级RDS的敏感度87.5%、特异度75.0%,超声评分25分预测Ⅳ级RDS的敏感度100%、特异度68.0%。肺部超声与胸部X线评估RDS疗效具有较高的一致性(κ=0.896,P<0.05)。结论肺部超声诊断RDS具有较高的特异度并可反映病情严重程度,评估疗效与胸部X线具有较高的一致性,可作为RDS诊断与疗效评估的检查手段。Objective To study the value of lung ultrasound(LUS)in the diagnosis and evaluation of therapeutic effects of neonatal respiratory distress syndrome(RDS).Method From April 2017 to April 2019,premature infants with RDS diagnosed based on clinical manifestations and chest X-ray(CXR)in the neonatal intensive care unit(NICU)of our hospital were retrospectively analyzed.Premature infants without cardiopulmonary disease during the same period were included as the control group.The LUS characteristics of RDS infants were analyzed and the LUS images of different degrees of RDS were compared.The correlation between LUS and CXR was analyzed and the therapeutic effects of pulmonary surfactant(PS)were evaluated using LUS and CXR.Result Sixty-nine premature infants were included in the RDS group and the control group,respectively.The positive rates of abnormal pleural line,abnormal A line,B line appearance and alveolar interstitial syndrome(AIS)in infants with RDS were 100%.71.0%RDS infants had pulmonary consolidation and 49.3%had"white lung".If pleural line abnormality,lung consolidation and white lung presented at the same time,the sensitivity,specificity,positive predictive value(PPV)and negative predictive values(NPV)of RDS were 40.5%,100%,100%and 62.7%,respectively.If pleural line abnormality,pulmonary consolidation and AIS presented at the same time,the sensitivity,specificity,PPV and NPV of RDS were 71.0%,100%,100%and 77.5%,respectively.The higher the RDS grade,the more lung consolidations(r=0.836,P<0.05)and higher LUS score(r=0.868,P<0.05).To predict the severity of RDS,the sensitivity and specificity of LUS score 10 for gradeⅡRDS were 80.0%and 94.4%,LUS score 15 for gradeⅢRDS were 87.5%and 75.0%,LUS score 15 for gradeⅣRDS were 87.5%and 75.0%,LUS score 25 for gradeⅣRDS were 100%and 68.0%.LUS and CXR had good consistency evaluating the therapeutic effects of PS(κ=0.896,P<0.05).Conclusion LUS has a high specificity for diagnosis of RDS and can reflect the severity of the disease,LUS also has good consistency wi

关 键 词：超声检查 呼吸窘迫综合征 新生儿 X线 婴儿 早产 

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