肺部超声新评分法评估新生儿呼吸窘迫综合征机械通气撤机时机的应用价值  

Application value of a new lung ultrasound scoring method in evaluating the evacuation timing of mechanical ventilation for neonatal respiratory distress syndrome

作　　者：江秋霞 黄嵘森 沈龙源 李晓庆 施丽景 吕国荣 JIANG Qiuxia;HUANG Rongsen;SHEN Longyuan;LI Xiaoqing;SHI Lijing;LYU Guorong(Department of Ultrasound,Quanzhou Women’s and Children’s Hospital,Fujian 362000,China)

机构地区：[1]福建省泉州市妇幼保健院儿童医院超声科,362000 [2]福建省泉州市妇幼保健院儿童医院麻醉科,362000 [3]福建省泉州市妇幼保健院儿童医院新生儿科,362000 [4]泉州医高专母婴健康服务应用技术协同创新中心

出　　处：《临床超声医学杂志》2021年第4期280-283,共4页Journal of Clinical Ultrasound in Medicine

基　　金：泉州市科技计划资助项目(2018N083S)。

摘　　要：目的探讨肺部十四分区超声评分法评估新生儿呼吸窘迫综合征(NRDS)患儿机械通气撤机时机的临床应用价值。方法选取我院新生儿重症监护室使用机械通气治疗的NRDS患儿62例,根据撤机结果分为撤机成功组49例和撤机失败组13例,在达到临床撤机标准拟拔管前行床旁肺部超声检查,采用肺部六分区法、十分区法、十二分区法及十四分区法对两组患儿进行肺部超声评分(LUS),撤机失败者于再次插管前和再次撤机前再行LUS。绘制受试者工作特征(ROC)曲线分析不同分区方法LUS对撤机时机的预测价值。结果两组患儿四种肺部分区法获得的LUS比较,差异均有统计学意义(均P<0.05)。撤机失败组经肺部超声检查发现存在:4例明显肺水肿,5例后肺部大范围肺实变,2例肺底部大范围肺实变,1例右上肺大片肺不张,1例肺部超声未见异常但心脏超声发现心功能不全。ROC曲线分析显示,肺部十四分区法较其他三种分区方法对撤机时机有更好的诊断效能,以40.5分为截断值,其预测撤机失败风险的曲线下面积0.965,敏感性92.31%,特异性93.88%。结论肺部十四分区法对NRDS患儿机械通气撤机时机的评估具有良好的应用价值,可早期预测撤机失败高风险患儿,进一步指导临床诊疗,提高撤机成功率。Objective To explore the clinical application value of the new fourteen-zone lung ultrasound scoring method in evaluating the evacuation timing of mechanical ventilation for neonatal respiratory distress syndrome(NRDS).Methods Sixty-two children with NRDS who were mechanically ventilated were involved in the NICU of our hospital were selected.Bedside lung ultrasound score(LUS)was performed before the children extubation when they reached the clinical evacuation standard,LUS was measured by six-zone method,ten-zone method,twelve-zone method and fourteen-zone method in two groups.According to the results of evacuation,the children were divided into the success group(n=49)and the failure group(n=13),the LUS of the two groups were compared.LUS was administered to the evacuation failure group before reintubation and before re-extubation.The ROC curve was used to analyze the diagnostic efficacy of LUS for the evacuation timing.Results There were significantly difference in LUS between the two groups for different four method(all P<0.05).In the failure group,the following pathology changers were found by lung ultrasonography:4 cases of obvious lung edema,5 cases of extensive lung consolidation,2 cases of extensive lung consolidation at the bottom of the lung,1 case of large atelectasis of the upper right lung,and 1 case of no abnormality in lung ultrasonography but cardiac dysfunction was found.Compared with the other three methods,the fourteen-zone lung ultrasound scoring method had a better diagnostic performance for the evacuation timing,taking 40.5 point as the cutoff value to predict the risk of evacuation failure,the area under the curve was 0.965,the sensitivity was92.31%,and the specificity was 93.88%.Conclusion The fourteen-zone lung ultrasound scoring method has good applicationvalue in evaluating the evacuation timing of mechanical ventilation in NRDS,which can identify high-risk children with earlyfailure of evacuation,guide further clinical diagnosis and treatment,and improve the success rate of evacuation.

关 键 词：超声检查 肺 肺部十四分区 新生儿呼吸窘迫综合征 机械通气 撤机时机 

分 类 号：R445.1[医药卫生—影像医学与核医学] R722.6[医药卫生—诊断学]