新生儿肺部疾病的超声诊断

Ultrasound scan for neonatal pulmonary diseases

目的探讨超声对新生儿肺部疾病的诊断价值，为新生儿肺部疾病提供简便可靠的诊断手段。方法2012年5月至8月，对入住北京军区总医院附属八一儿童医院新生儿重症监护病房的105例新生儿在入院后24h内进行了肺部超声检查，包括呼吸窘迫综合征（respiratory distress syndrome，RDS）40例、胎粪吸入综合征18例、新生儿湿肺17例和同期住院的非肺部疾病患儿30例。肺部疾病者均有相应临床表现，并经动脉血气分析和胸部X线检查予以确诊。结果（1）正常新生儿肺组织在超声下呈低回声（黑色），胸膜线呈光滑、清晰、规则的高回声，A-线也呈高回声，与胸膜线平行，清晰可见。（2）RDS：100．0％（40／40）的RDS患儿肺部超声表现为肺实变、胸膜线异常、A-线消失和肺泡间质综合征。12．5％（5／40）的患儿表现为不同程度的胸腔积液。（3）湿肺：双肺点是湿肺的特异性肺超声表现（100．0％，17／17）。（4）胎粪吸入综合征的肺部超声表现：100．0%（18／18）的胎粪吸入综合征的患儿有胸膜下局灶性实变、肺泡间质综合征、病变区胸膜线异常和A-线消失，但均为非特异性改变。（5）RDS与湿肺鉴别诊断：5例患儿表现为严重呼吸困难，胸部X线呈“白肺”样表现，结合临床表现诊断RDS。但其中4例肺超声仅见严重肺水肿的影像学改变、1例合并胸腔积液，均符合湿肺的超声特点，其临床经过也与湿肺一致。（6）指导撤除呼吸机：3例RDS患儿撤除呼吸机后呼吸困难，胸部X线无明显异常，但肺部超声检查显示患儿肺部仍存在胸膜下局灶性肺不张。结论超声诊断新生儿肺部疾病准确可靠，且简便、无创、费用低、可在床边开展、可随时检测、无射线损伤，值得在新生儿病房内开展。

Objective To evaluate the value of lung sonography in diagnosis of neonatal pulmonary diseases and to provide a reliable and simple method for diagnosing neonatal pulmonary diseases. Methods From May 2012 to August 2012, 105 newborns who admitted into Bayi Children＇s Hospital were enrolled into this study, including respiratory distress syndrome 40 cases （three of them with difficulty in withdrawing mechanical ventilation）, meconium aspiration syndrome 17 cases, wet lung of newborn 17 cases and 30 health neonates without lung diseases. Lung ultrasound was performed at bedside by a single expert physician within the first 24 h of life. All patients with neonatal lung diseases were diagnosed by clinical manifestations, arterial blood gas analysis and chest X ray. Results （1） Lung sonography of normal neonates showed hypo echo （black）, smooth and clear hyper-echoic pleural line. A-line was hyper-echo too. （2） All 40 neonates with respiratory distress syndrome showed lung consolidation with air bronchograms; abnormal pleural line, disappeared A lines, pleural effusion and alveolar-interstitial syndrome. Five out of the 40 （12.5%） infants showed pleural effusion. （3） All 18 meconium aspiration syndrome infants showed focal lung consolidation under pleural membrane, alveolar-interstitial syndrome, atypical changes of abnormal pleural line and disappeared A line in lesion area with lung sonography. （4） All infants with wet lung of newborn （100.0% ,17/17） showed ＂double lung point＂, with which all wet lung of newborn could be diagnosed. （5） Differential diagnosis of respiratory distress syndrome with wet lung of newborn： five infants with severe dyspnea showed ＂ white lung＂ in X ray and were diagnosed as respiratory distress syndrome, while sonography only showed severe lung edema and one infant showed pleural effusion which was in accordance with wet lung of newborn, so was their courses of disease. （6） Three cases of respiratory distress syndrome showed dyspnea after withdrawing mechanical ventilation,and lung sonography showed local atelectasis but normal in X-ray. Conclusions Lung ultrasound has many advantages, such as accurate, reliable, no radiation damage, low-cost and simple; therefore, it is feasible in neonatal ward.