简化肺脏超声在预测晚期早产儿和足月儿生后早期呼吸支持中的应用  

Application of simplified lung ultrasound performed shortly after birth in the respiratory support needs of late preterm and term infants

作　　者：张睿洁 郤冠楠 王雪峰[1] 林昕奥 戴家乐[1] 樊晓波 汪吉梅[1] ZHANG Ruijie;XI Guannan;WANG Xuefeng;LIN Xin’ao;DAI Jiale;FAN Xiaobo;WANG Jimei(Department of Neonatology,Obstetrics and Gynecology Hospital of Fudan University,Shanghai 200001,China)

机构地区：[1]复旦大学附属妇产科医院新生儿科,上海200001

出　　处：《临床儿科杂志》2024年第8期714-721,共8页Journal of Clinical Pediatrics

基　　金：上海市卫生健康委员会资助项目(No.202040402)。

摘　　要：目的探究简化后的8区肺脏超声检查方法在预测晚期早产儿和足月儿生后早期呼吸支持中的应用。方法纳入2019年6月至2020年1月生后4小时内出现呼吸困难症状的晚期早产儿和足月儿。分别于生后0.5、1.0、2.0、4.0 h中任一时间点纳入患儿进行肺超声检查。在生后早期观察到的肺超声征象中,“单纯A-线”和“散在B-线”归为低风险征象,“融合B-线”和“实变”归为高风险征象。通过logistic回归确定了高风险征象与肺疾病的相关性(OR)。通过受试者工作曲线和曲线下面积(AUC)比较了肺部超声和现有症状评分工具(ACoRN评分)预测呼吸支持的准确性,使用Youden指数计算其最佳的敏感性和特异度。结果共纳入310例新生儿。随访至生后3天发现其中74例患儿需要呼吸支持,236例患儿不需要呼吸支持。高风险征象预测早产儿呼吸支持的AUC为0.93(95%CI:0.85~1.00),截断值为3;预测足月儿呼吸支持的AUC为0.88(95%CI:0.82~0.94),截断值为2。借助临床症状和体征(ACoRN评分)预测早产儿呼吸支持的AUC为0.69(95%CI:0.51~0.87),预测足月儿呼吸支持的AUC为0.74(95%CI:0.67~0.81),显著低于高风险征象(P=0.006)。结论简化肺超声检查方法可用于生后早期出现呼吸困难患儿的呼吸支持预测。Objective To investigate the application of a simplified 8-zone lung ultrasound examination method in predicting early postnatal respiratory support in late preterm and term neonates.Methods Late preterm and term infants who developed dyspnea within 4 hours after birth from June 1,2019 to January 1,2020 were included.The infants underwent lung ultrasound at any of the postnatal time points:0.5 h,1.0 h,2.0 h,and 4.0 h.Among the lung ultrasound signs observed early postnatally,"isolated A-lines"and"scattered B-lines"were categorized as"low-risk"signs,while"coalescent B-lines"and"consolidation"were categorized as"high-risk"signs.The association between"high-risk"signs and lung disease was determined through logistic regression(odds ratio,OR).The accuracy of lung ultrasound and an existing symptom scoring tool(ACoRN score)in predicting respiratory support was compared using the receiver operating characteristic curve and area under the curve(AUC).The optimal sensitivity and specificity were calculated using the Youden index.Results A total of 310 newborns were included.Follow-up until 3 days postnatally found that 74 infants required respiratory support,while 236 did not.The AUC for"high-risk"signs predicting respiratory support in preterm infants was 0.93(95%CI:0.85-1.00)with a cut-off value of 3;for full-term infants,it was 0.88(95%CI:0.82-0.94)with a cutoff value of 2.Using clinical symptoms and signs(ACoRN score)for prediction,the AUC was 0.69(95%CI:0.51-0.87)for preterm infants and 0.74(95%CI:0.67-0.81)for full-term infants,significantly lower than the"high-risk"signs(P=0.006).Conclusion The simplified lung ultrasound method can be used to predict respiratory support in infants with early postnatal respiratory distress.

关 键 词：简化肺超声 呼吸支持 新生儿 

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