床旁肺脏超声评估肺表面活性物质治疗新生儿呼吸窘迫综合征疗效的价值

Effect of surfactant on respiratory distress syndrome: evaluation by bedside pulmonary ultrasonography

目的 探讨床旁肺脏超声与胸部X线检查的一致性及肺脏超声评分(lung ultrasonography score,LUS)评估肺表面活性物质(pulmonary surfactant,PS)治疗新生儿呼吸窘迫综合征(respiratory distress syndrome,RDS)效果的价值。 方法 选取2016年1月至2017年12月济宁医学院附属医院新生儿重症监护室收治的RDS早产儿,将每侧肺脏分为前上、前下、侧方3个区域,分别在应用PS前及应用PS后6-12 h对双肺6个区域进行床旁肺脏超声检查及胸部X线检查,观察肺脏超声表现,根据B线多少及是否合并肺实变进行LUS评估,分析LUS与胸部X线检查的一致性。 结果 共纳入45例RDS早产儿,应用PS前胸部X线Ⅰ、Ⅱ、Ⅲ、Ⅳ级分别为5例、21例、12例、7例;LUS 0-6、7-12、13-18分分别为5例、37例、3例,LUS中位数为10分。应用PS后6-12 h胸部X线Ⅰ、Ⅱ、Ⅲ、Ⅳ级分别为18例、17例、8例、2例;LUS 0-6、7-12、13-18分分别为21例、20例、4例,LUS中位数为7分。应用PS后LUS明显低于应用PS前,差异有统计学意义(P<0.001);应用PS前及应用PS后LUS与胸部X线分级均成正相关,r值分别为0.688、0.777,P均<0.001。 结论 LUS与胸部X线表现具有一致性,可以评估RDS患儿应用PS的疗效,而且更直观、快速、无辐射。

Objective To study the relationship between the lung ultrasonography and the chest X-ray and to study the value of lung ultrasonography score (LUS) in evaluating the effect of pulmonary surfactant (PS) on respiratory distress syndrome (RDS) of newborn. Method Preterm infants admitted to the neonatal intensive care unit of our Hospital from January 2016 to December 2017 and diagnosed with RDS were prospectively studied. LUS examinations were performed prior to, and within the first 6-12 hours after surfactant administration, chest X-rays were also performed at the same time so as to evaluate the effects of surfactant replacement therapy and the correlation between the lung ultrasonography and the chest X-rays. Lung ultrasonography findings at a total of six sites, with three sites in each lung were scored based on the presence of normal finding, the amount of B-lines and subpleural consolidations. Result A total of 45 preterm infants with RDS were enrolled. The cases of X-ray grades Ⅰ, Ⅱ, Ⅲ and Ⅳ before PS administration were 5 cases, 21 cases, 12 cases and 7 cases respectively. The scores of LUS 0-6, 7-12, 13-18 were 5 cases, 37 cases and 3 cases respectively, and the median of LUS was 10 points. Chest X-ray grades Ⅰ, Ⅱ, Ⅲ and Ⅳ within 6-12 hours after PS administration were 18 cases, 17 cases, 8 cases and 2 cases respectively. LUS of 0-6, 7-12, 13-18 were 21 cases, 20 cases and 4 cases respectively. The median of LUS after PS was 7 points. LUS after PS application was significantly lower than that before PS application (P<0.001). The LUS was positively correlated with the grades of X-ray before and after surfactant administration (before surfactant administration r=0.688, P<0.001, after surfactant administration r=0.777, P<0.001). Conclusion LUS is positively correlated with the grade of chest X-ray and might enable an early detection of the surfactant replacement therapy effects in RDS. Further studies are necessary to define the role of LUS in this field.