肺部超声评分、膈肌超声联合常规指标预测小儿重症肺炎并发ARDS的价值  

The Value of Lung Ultrasound Score and Diaphragm Ultrasound Combined with Routine Indicators in Predicting ARDS in Children with Severe Pneumonia

作　　者：宝凌云[1] 李明盼 BAO Lingyun;Li Mingpan(Kunming Children’s Hospital Neonate Department,Kunming Yunnan 650021,China)

机构地区：[1]昆明市儿童医院新生儿科,云南昆明650021

出　　处：《昆明医科大学学报》2025年第3期110-116,共7页Journal of Kunming Medical University

基　　金：昆明市卫健委科研课题(2022-06-03-007)。

摘　　要：目的 探究肺部超声评分(LUS)、膈肌超声联合常规指标预测小儿重症肺炎(SP)并发急性呼吸窘迫综合征(ARDS)的价值。方法 选取2022年8月至2023年8月昆明市儿童医院SP患儿160例,均行肺部超声、膈肌超声检查获取LUS、膈肌超声参数[膈肌移动度(DM)、膈肌厚度变化率(TF)],根据SP患儿住院期间是否并发ARDS分为ARDS组67例和非ARDS组93例,比较两组入院时一般资料、血清炎症因子水平、LUS、膈肌超声参数,分析SP患儿并发ARDS的影响因素,并分析LUS、膈肌超声参数预测SP患儿并发ARDS的价值。结果 SP患儿住院期间ARDS发生率为41.88%(67/160);ARDS组入院时APS、APACHEⅡ评分、血清C反应蛋白(CRP)、白介素-6(IL-6)、高迁移率族蛋白B1(HMGB1)水平、LUS、DM高于非ARDS组,TF低于非ARDS组(P <0.05);入院时APS、APACHEⅡ评分及血清CRP、IL-6、HMGB1水平、LUS、DM、TF均为SP患儿并发ARDS的影响因素(P <0.05);LUS、DM、TF预测ARDS的曲线下面积(AUC)分别为0.718、0.742、0.720;常规预测方案(入院时APS、APACHEⅡ评分及血清CRP、IL-6、HMGB1水平联合)的AUC为0.852,新预测方案(常规预测方案基础上联合LUS、DM、TF)的AUC为0.930,新预测方案的AUC明显大于常规预测方案的AUC(P <0.05)。结论 LUS、膈肌超声参数DM、TF与SP患儿并发ARDS显著相关,联合常规指标可为临床预测SP患儿并发ARDS提供可靠依据。Objective To explore the value of lung ultrasound score(LUS)and diaphragm ultrasound combined with routine indicators in predicting the occurrence of acute respiratory distress syndrome(ARDS)in children with severe pneumonia(SP).Methods A total of 160 patients with SP were selected from Kunming Children’s Hospital from August 2022 to August 2023,all of whom underwent lung ultrasound and diaphragm ultrasound examination to obtain LUS and diaphragm ultrasound parameters[diaphragm mobility(DM),diaphragm thickness change rate(TF)].The patients with SP were divided into ARDS group and non-ARDS group according to whether they were complicated with ARDS during hospitalization.The general data,serum inflammatory factor levels,LUS and diaphragm ultrasound parameters were compared between the two groups at admission,and the influencing factors of ARDS in children with SP were analyzed,and the value of LUS and diaphragm ultrasound parameters in predicting ARDS in children with SP was analyzed.Results The incidence of ARDS in SP patients was 41.88%(67/160).APS,APACHEⅡscores,serum C-reactive protein(CRP),interleukin-6(IL-6),high mobility group protein B1(HMGB1)levels,LUS and DM in ARDS group were higher than those in non-ARDS group,TF were lower than those in non-ARDS group(P<0.05).APS,APACHEⅡscores,serum CRP,IL-6,HMGB1 levels,LUS,DM,TF were the influencing factors of ARDS in SP children at admission(P<0.05).The area under the curve(AUC)of LUS,DM and TF predicted ARDS were 0.718,0.742 and 0.720,respectively.The AUC of the conventional prediction scheme(APS,APACHEⅡscore combined with serum CRP,IL-6 and HMGB1 levels at admission)was 0.852,while that of the new prediction scheme(combined with LUS,DM and TF based on the conventional prediction scheme)was 0.930.The AUC of the new prediction scheme was significantly higher than that of the conventional prediction scheme(P<0.05).Conclusion LUS,DM,TF,and SP parameters of the diaphragm are significantly correlated with ARDS in children with SP,and the combination of routine in

关 键 词：重症肺炎 儿童 急性呼吸窘迫综合征 肺部超声 膈肌超声 

分 类 号：R816.41[医药卫生—放射医学]