肺脏超声在诊断NRDS及规范指导肺表面活性物质治疗中的应用研究  

The application of lung ultrasound in the diagnosis of NRDS and the standardized guidance of pulmonary surfactant treatment

作　　者：封在李 杨明杰 雷嘉 朱丽宏 尹兆青 李蕊 徐芳 郭云华 FENG Zaili;YANG Mingjie;LEI Jia;ZHU Lihong;YIN Zhaoqing;LI Rui;XU Fang;GUO Yunhua(Kunming Medical University,Kunming,Yunnan 650000,China;Department of Neonatology,The Dehong Hospital Affiliated to the Kunming Medical University/The Dehong People’s Hospital,Mangshi,Yunnan 678400,China;Department of Imaging,The Dehong Hospital Affiliated to the Kunming Medical University/The Dehong People’s Hospital,Mangshi,Yunnan 678400,China;Department of Obstetrics,The Dehong Hospital Affiliated to the Kunming Medical University/The Dehong People’s Hospital,Mangshi,Yunnan 678400,China)

机构地区：[1]昆明医科大学,昆明650000 [2]昆明医科大学附属德宏医院/德宏州人民医院新生儿科,云南芒市678400 [3]昆明医科大学附属德宏医院/德宏州人民医院影像科,云南芒市678400 [4]昆明医科大学附属德宏医院/德宏州人民医院产科,云南芒市678400

出　　处：《重庆医学》2024年第3期339-343,共5页Chongqing medicine

基　　金：国家自然科学基金项目(81960290);云南省科技厅科技计划项目(202201AY070001-220);云南省教育厅科学研究基金项目(2019J1316);云南省德宏州中青年学术和技术带头人后备人才(英才兴边计划)项目(2023RC001);德宏州人民医院(昆明医科大学附属德宏医院)科学研究基金项目(2022DY008)。

摘　　要：目的探讨肺脏超声(LUS)在诊断新生儿呼吸窘迫综合征(NRDS)、新生儿短暂性呼吸增快(TTN)及规范指导NRDS患儿肺表面活性物质(PS)治疗中的应用价值。方法选取2019年3月至2023年1月在昆明医科大学附属德宏医院出生的217例胎龄<34周的早产儿为研究对象,对其进行LUS检查,当LUS检查结果为NRDS时,及时进行PS治疗,之后使用LUS监测肺复张情况决定是否再次使用PS治疗,评价LUS的监测效果。结果217例早产儿中诊断为NRDS 55例(25.34%),诊断为TTN 37例(17.05%)。37例TTN患儿LUS监测发现2例(5.40%)转变为NRDS,12例(32.43%)转变为ARDS。55例NRDS患儿使用LUS监测指导PS治疗,第1次PS治疗后22例(40.00%)仍有肺不张,第2次PS治疗后8例(14.54%)仍有肺不张,第3次PS治疗后3例(5.45%)仍有肺不张,第4次PS治疗后无肺不张。结论LUS适用于检查、诊断、监测NRDS、TTN,并能规范指导NRDS患儿PS治疗。Objective To explore the application value of lung ultrasound(LUS)in the diagnosis of neonatal respiratory distress syndrome(NRDS)and transient tachypnea of the newborn(TTN),and to guide the treatment of pulmonary surfactant(PS)in children with NRDS.Methods From March 2019 to January 2023,a total of 217 premature infants with gestational age<34 weeks born in Dehong Hospital Affiliated to Kunming Medical University were selected as the research objects,and LUS examination and monitoring were performed.When the LUS examination results were NRDS,PS treatment was performed in time,and then LUS was used to monitor the lung recruitment to determine whether PS treatment was used again,and the monitoring effect of LUS was evaluated.Results Among the 217 premature infants,55 cases(25.34%)were diagnosed as NRDS and 37 cases(17.05%)were diagnosed as TTN.LUS monitoring of 37 TTN children showed that two cases(5.40%)were converted to NRDS and 12 cases(32.43%)were converted to ARDS.A total of 55 cases of NRDS were treated with PS guided by LUS monitoring.After the first PS treatment,22 cases(40.00%)still had atelectasis,eight cases(14.54%)still had atelectasis after the second PS treatment,three cases(5.45%)still had atelectasis after the third PS treatment,and no atelectasis after the fourth PS treatment.Conclusion LUS is suitable for the examination,diagnosis and monitoring of NRDS and TTN,and can guide the treatment of PS in children with NRDS.

关 键 词：早产儿 新生儿呼吸窘迫综合征 新生儿湿肺 肺脏超声 肺表面活性物质 肺泡复张 

分 类 号：R722.1[医药卫生—儿科]