肺脏超声对新生儿呼吸窘迫综合征的诊断价值

Lung ultrasonography for the diagnosis of neonatal respiratory distress syndrome： a pilot study

目的研究新生儿呼吸窘迫综合征（RDS）的超声影像学特点及肺脏超声对RDS的诊断价值，为临床提供可靠、简便、无创的诊断手段。方法2012年5至9月，对在我院新生儿重症监护中心住院、经临床、动脉血气分析和胸部x线检查确诊为RDS、同时行肺部超声检查的45例患儿为研究组，同期住院的30例非肺病患儿为对照组。在安静状态下，患儿取仰卧、侧卧或俯卧位，以腋前线、腋中线、腋后线为界，将肺脏分成前、侧、后三个区域，探头与肋骨垂直分别对双侧肺脏的每个区域进行扫查，并与传统胸部X线检查结果作对照。结果（1）肺实变、胸膜线异常、肺及A-线消失等征象在本组所有RDS患儿均存在（100％），而在正常对照组均不存在（O％）（P〈0．001）；肺搏动在RDS患儿的发现率为80％、而对照组为0％（P〈0．001）；胸腔积液在RDS为13．3％、对照组为0％（P〈0．001）；B-线在RDS组为4．4％、对照组为26．7％（P=0．012）。（2）肺实变、胸膜线异常及肺三种超声征象同时存在对诊断RDS的敏感性和特异性均为100％，肺实变、胸膜线异常及A．线消失同时存在时对诊断RDS的敏感性和特异性也均为100％。（3）实变时超声下见肺搏动对RDS的进一步确诊具有重要价值，肺搏动对诊断RDS的敏感性80％，特异性为100％。结论RDS的超声影像学特点主要包括肺实变及支气管充气征、胸膜线异常、A-线消失、肺搏动及双侧肺或肺泡－间质综合征等。超声诊断RDS准确可靠，敏感性高、特异性强，且具有简便、无创、可在床边开展、可随时检测、可避免射线损伤等优点。

Objective The diagnosis of respiratory distress syndrome （RDS） is usually based on clinical manifestations, arterial blood gas analysis and chest x-ray. Lung ultrasounds are typically not included in the diagnostic work-up of neonatal RDS. Recently, uhrasounds have been used extensively and successfully in the diagnosis of many kinds of lung diseases, but few studies have addressed neonatal RDS. This study aimed to evaluate the value of lung ultrasound in the diagnosis of neonatal RDS. Method From May,2012 to September,2012, 45 newborn infants with RDS and 30 neonates without lung disease were enrolled into this study. Lung ultrasound was performed at bedside by a single expert physician in the first 24 h of life before exogenous pulmonary surfactant administration. The transthoraeic approach was performed with longitudinal scans of the anterior, lateral and posterior chest walls. A conventional antero- posterior chest X rag was performed at bedside in the patients immediately when lung ultrasound was finished. Result The ultrasound signs of lung consolidation, pleural line abnormalities, bilateral ＂white lung＂ and A-line disappearance were seen in 100% of RDS patients while they were not found in any of the controls（P 〈0. 001 ）. Lung pulse was 80% in RDS patients and in 0% of controls, respectively （P = 0. 001 ）. The pleural effusion were 13.3% in RDS patients and 0% in controls, respectively （P 〈0. 001 ）. B-lines existed in 4. 4% of RDS patients and in 26. 7% of controls （P = 0. 012）. Both the sensitivity and specificity were 100% when ultrasonic signs of lung consolidation, pleural line abnormalities and bilateral ＂white lung＂ coexisted or when lung consolidation, pleural line abnormalities and A-line disappearance coexisted. The presence of lung pulse demonstrated a sensitivity of 80% and a specificity of 100% in diagnosis of RDS. Conclusion The main ultrasound imaging features of neonatal RDS include lung consolidation with air bronchograms, pleural line abnormalities, lung pulse and bilateral ＂white lung＂ or alveolar-interstitial syndrome. It is accurate and reliable that using ultrasound to diagnose neonatal RDS, which also has many other advantages including non-ionizing, can be performed at bedside, easy-operatinng, can be repeated several times in a day without hazards to the operators and the patients. Therefore, it deserves to be carried out in the neonatal ward.