肺部超声观察阴道分娩和剖宫产双胞胎新生儿出生后2天内肺液清除情况的研究  

Pulmonary fluid clearance in twin neonates with vaginal delivery or cesarean section measured by lung ultrasound in the first two days of life

作　　者：余蓉蓉[1] 林晓[2] 梁雅琴[1] 盛安群 李泽阳[2] YU Rongrong;LIN Xiao;LIANG Yaqin;SHENG Anqun;LI Zeyang(Department of Pediatrics,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]温州医科大学附属第一医院儿科,325000 [2]温州医科大学附属第一医院超声科,325000

出　　处：《浙江医学》2021年第23期2576-2580,共5页Zhejiang Medical Journal

基　　金：温州市科技计划项目(Y20170636)。

摘　　要：目的利用肺部超声观察阴道分娩和剖宫产双胞胎新生儿出生后2天内的肺液清除情况。方法选取2018年2月至2019年12月在温州医科大学附属第一医院产科出生的33对双胞胎66例新生儿为研究对象。分别于出生时、生后第1天、生后第2天对双胞胎新生儿进行肺部超声检查,根据肺部超声图像B线的量及密集程度,将肺部超声检查结果分为I~IV级,仅IV级代表肺液清除完全、通气良好。根据分娩方式分为阴道分娩组8例和剖宫产组58例,比较两组新生儿出生后2天内的肺部超声分级结果;根据双胞胎出生的先后顺序分为双胎之大组33例和双胎之小组33例,比较两组新生儿出生后2天内的肺部超声异常率及具体等级程度差异。结果阴道分娩组和剖宫产组新生儿出生时、生后第1天、生后第2天肺部超声分级比较差异均无统计学意义(均P>0.05)。双胎之大组和双胎之小组出生时、生后第2天肺部超声异常率比较差异均无统计学意义(均P>0.05),而双胎之小组生后第1天肺部超声异常率高于双胎之大组,差异有统计学意义(P<0.05)。出生时、生后第1天、生后第2天,分别有7、16、9对双胞胎之小者肺部超声等级程度比双胎之大者差,分别有3、3、1对双胞胎之大者肺部超声等级程度比双胎之小者差。结论双胞胎新生儿生后过渡至宫外生活时,肺液清除存在一定困难,且双胎之小者似乎更为明显。阴道分娩和剖宫产出生的双胞胎新生儿,出生后2天内的肺液清除过程无明显差别。Objective To evaluate the pulmonary fluid clearance after birth in twin neonates with vaginal delivery or cesarean section by lung ultrasound(LUS).Methods Thirty-three pairs of twins born in the Department of Obstetrics of the First Affiliated Hospital of Wenzhou Medical University from February 2018 to December 2019 were included in the study.The ultrasound exams were performed with Sonosite M-Turbo portable color ultrasound diagnostic instrument,with high frequency linear probe(6-13 MHz,scanning depth 4-6 cm)in different lung areas of the twin neonates at birth,on the 1st and the 2nd day after birth.According to the amount and intensity of B lines,LUS results were classified as grade I to IV,and grade IV represented full clearance of pulmonary fluid and good ventilation of the lung.There were 8 neonates with vaginal delivery(4 pairs)and 58 neonates with cesarean delivery(29 pairs)and LUS grades within 2 days after birth were compared between the two groups.Also neonates were divided into elder twin group(n=33)and the younger twin group(n=33)according to the birth order,and the abnormal rates of LUS and the LUS grades within 2 days after birth were compared between elder and younger twin groups.Results There were no significant differences in LUS grades at birth,on the 1st and the 2nd day after birth between the vaginal delivery group and the cesarean delivery group(all P>0.05).There were no significant difference in the abnormal rate of LUS at birth and on the 2nd day after birth between the elder and the younger twin groups(both P>0.05),but the abnormal rate of LUS in the younger twin group was higher than that in the elder twin group on the 1st day after birth(P<0.05).In addition,for only 3 pairs of twins at birth,3 pairs on the 1st and 1 pair on the 2nd day after birth,the younger twins had better LUS grade than the elder,while for 7 pairs of twins at birth,16 pairs on the 1st and 9 pairs on the 2nd day after birth,the younger twins had worse LUS grade than the elder.Conclusion Twin neonates have difficulty

关 键 词：双胞胎 肺部超声 阴道分娩 剖宫产 肺液清除 

分 类 号：R722.1[医药卫生—儿科]