肺部超声在支气管肺泡灌洗治疗新生儿肺不张效果评估中的应用价值  

Value of the evaluation of lung ultrasound on the effect of bronchoalveolar lavage treating neonatal atelectasis

作　　者：郑双 乔彦霞[1] 张明 刘素丹 张新荣[1] 马晓康 扈科娜 ZHENG Shuang;QIAO Yanxia;ZHANG Ming;LIU Sudan;ZHANG Xinrong;MA Xiaokang;HU Kena(Department of Neonatology,the fourth Hospital of Shijiazhuang,Shijiazhuang 050000,China)

机构地区：[1]石家庄市第四医院新生儿科,050000 [2]石家庄市第四医院放射科,050000

出　　处：《临床超声医学杂志》2021年第7期550-552,共3页Journal of Clinical Ultrasound in Medicine

基　　金：2019年度河北省医学科学研究重点课题计划项目(20191434)。

摘　　要：目的探讨肺部超声动态评估支气管肺泡灌洗(BLA)治疗新生儿肺不张的效果。方法收集我院新生儿重症监护室收治的60例肺不张患儿,经肺部超声标记肺不张的部位后行纤维支气管镜下BLA治疗。每次治疗后均行肺部超声检查观察肺不张恢复程度以决定是否继续进行灌洗。记录肺部啰音消失时间、机械通气时间及抗生素使用时间;比较治疗前及治疗1周后的酸碱度、动脉血氧饱和度(SaO2)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2);观察患儿治疗效果及不良反应发生情况。结果60例患儿肺部啰音消失时间、机械通气时间及抗生素使用时间分别为(5.34±1.21)d、(7.15±1.30)d、(8.10±2.07)d,治愈率为86.67%、有效率为11.67%。其中灌洗45次患儿12例,均治愈;灌洗67次患儿28例,治愈25例、有效3例;灌洗89次患儿20例,治愈15例、有效4例、无效1例。治疗后1周SaO2、PaO2均较治疗前明显增高,PaCO2较治疗前明显降低,差异均有统计学意义(均P<0.05)。在治疗过程中无肺水肿、呼吸困难、气胸、心脏骤停等严重不良反应发生,出现哭声嘶哑4例、气管黏膜损伤6例、低氧血症20例,均经治疗后好转。结论肺部超声能动态评估纤维支气管镜下BLA治疗新生儿肺不张的疗效,具有重要的临床应用价值。Objective To explore the value of dynamic evaluation of lung ultrasound(LUS)on the effect of bronchoalveolar lavage(BLA)treating neonatal atelectasis.Methods A total of 60 children with atelectasis who were taken as study objects in the neonatal intensive care unit of our hospital.The BLA treatment under fiberbronchoscopy was carried out after LUS labeling location of atelectasis.After each treatment,LUS examination was conducted to observe the degree of atelectasis recovery to determine whether to continue lavage.The disappearance time of pulmonary rales,mechanical ventilation time and antibiotic service time were recorded.The pH,arterial oxygen saturation(SaO2),arterial oxygen partial pressure(PaO2)and arterial carbon dioxide partial pressure(PaCO2)was compared before and 1 week after treatment.The adverse reactions were observed.Results The disappearance time of pulmonary rales,mechanical ventilation time and antibiotic service time was(5.34±1.21)d,(7.15±1.30)d,(8.10±2.07)d,respectively.The cure rate was 86.67%and the effective rate was 11.67%in60 cases.12 children were lavaged for 4~5 times,all of which were cured.28 children were lavaged for 6~7 times,25 cases cured and 3 cases effective.20 children were lavaged for 8~9 times,15 cases cured,4 cases effective and 1 case ineffective.1 week after treatment,SaO2 and PaO2 were significantly higher than those before treatment,and PaCO2 was significantly lower than that before treatment(all P<0.05).During the treatment,there were no serious adverse reactions such as pulmonary edema,dyspnea,pneumothorax and cardiac arrest.There were 4 cases of crying hoarseness,6 cases of tracheal mucosal injury and 20 cases of hypoxemia,all of which improved after treatment.Conclusion The therapeutic effect was significant and the safety was high of BLA in the treatment of neonatal atelectasis under fiberoptic bronchoscopy with dynamic evaluation of LUS.

关 键 词：超声检查 肺 肺不张 新生儿 支气管肺泡灌洗 

分 类 号：R445.1[医药卫生—影像医学与核医学] R563.4[医药卫生—诊断学]