肺部超声新评分法评估新生儿呼吸窘迫综合征肺泡表面活性物质的疗效  

New Lung Ultrasound Scoring Method in the Clinical Observation of the Efficacy of NRDS Pulmonary Surfactant Replacement Therapy

作　　者：江秋霞 吕国荣 李晓庆[4] 施丽景[1] 黄嵘森[1] 沈龙源 JIANG Qiuxia;LV Guorong;LI Xiaoqing;SHI Lijing;HUANG Rongsen;SHEN Longyuan(不详;Quanzhou Medical College Maternal and Child Health Service Application Technology Collaborative Innovation Center,Quanzhou 362000,China;Department of Ultrasound,Second Affiliated Hospital of Fujian Medical Uiversity,Quanzhou 362000,China)

机构地区：[1]泉州市儿童医院·妇幼保健院超声科,福建泉州362000 [2]泉州医高专母婴健康服务应用技术协同创新中心,福建泉州362000 [3]福建医科大学附属第二医院超声科,福建泉州362000 [4]泉州市儿童医院·妇幼保健院新生儿科,福建泉州362000 [5]泉州市儿童医院·妇幼保健院麻醉科,福建泉州362000

出　　处：《中国医学影像学杂志》2021年第5期464-468,共5页Chinese Journal of Medical Imaging

基　　金：泉州市科技计划资助(2018N083S)。

摘　　要：目的探讨肺部十四分区超声新评分法在新生儿呼吸窘迫综合征(NRDS)患儿使用肺泡表面活性物质(PS)替代治疗效果观察的应用价值。资料与方法选取新生儿重症监护室使用PS替代治疗的NRDS患儿80例,患儿在使用PS前及使用PS后12、24、48、72 h进行肺部超声评分(LUS),记录肺部六分区法、十分区法、十二分区法和十四分区法的LUS,同时行胸部X线检查,比较肺部十四分区超声新评分法对NRDS患儿使用PS替代治疗效果观察的价值。结果PS治疗后12、24、48及72 h肺部十四分区法的LUS分别为(38.6±13.1)分、(36.4±14.3)分、(31.2±13.1)分、(25.8±12.4)分,差异有统计学意义(P<0.001)。PS治疗后12 h肺部十四分区法LUS改变与胸部X线改善程度相似,而其他3种评分法LUS改变与胸部X线改善较不同步,存在分离现象。肺部病变性质改善顺序依次为胸膜下实变范围减小或消失、B线数目减少、A线重新出现和胸膜线渐清晰。肺部病变部位改善顺序依次为前胸部、侧胸部、后胸部及肺底。结论肺部十四分区法对PS替代治疗的早期疗效观察较其他3种LUS更好,可作为评估PS替代治疗效果的有效影像学方法。Purpose To evaluate the efficacy of the new method of fourteen-zone lung scoring in the treatment of neonatal respiratory distress syndrome(NRDS)with pulmonary surfactant(PS).Materials and Methods Eighty cases of NRDS children receiving PS treatment in NICU of our hospital were selected.Lung ultrasound score(LUS)was performed for the children before and after PS at 12,24,48 and 72 hours.The LUS of the six-zone lung scoring,ten-zone lung scoring,twelve-zone lung scoring,and fourteen-zone lung scoring were recorded respectively.LUS was performed simultaneously with chest X-ray examination(CXR),to explore the clinical value of fourteen-zone lung scoring method in the treatment of NRDS children with PS substitution therapy.Results After PS,the LUS of fourteen-zone lung scoring method at 12,24,48 and 72 h were 38.6±13.1,36.4±14.3,31.2±13.1,25.8±12.4,respectively,with statistical significance(P<0.001).After PS treatment,the change of LUS in the fourteen-zone lung scoring method at 12 h was synchronized with the improvement of chest X-ray,while the change of LUS in the other three methods was less synchronized with the improvement of chest X-ray,showing a separation phenomenon.The order of improvement of pulmonary lesion quality was the small or disappeared sub-pleural consolidation,the decrease of B-line number,the reappearance of A-line and the gradually clear pleural line.The order of improvement of pulmonary lesions was anterior chest,lateral chest,posterior chest and lung base.Conclusion The early curative effect of fourteen-zone lung scoring method on PS treatment is better than that of the other three LUS,it can be used as an effective imaging method to evaluate the effect of PS replacement therapy.

关 键 词：呼吸窘迫综合征 新生儿 超声检查 多普勒 彩色 肺部十四分区超声新评分法 肺泡表面活性物质 治疗结果 

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]