新生儿肺出血的超声诊断

Diagnosis of pulmonary hemorrhage of the newborn infants using lung ultrasonography

目的探讨肺脏超声诊断新生儿肺出血的准确性与可靠性。方法回顾性病例对照研究，以2014年1月至2016年5月，在陆军总医院附属八一儿童医院新生儿重症监护中心住院的肺出血患儿42例为研究对象，均根据病史、临床表现和胸部X线检查诊断为肺出血、并接受肺脏超声检查。以同期住院的100例无肺部病变但接受肺脏超声检查的新生儿为对照，归纳和总结肺出血的肺脏超声影像学特点。肺脏超声检查在安静状态下，患儿取仰卧、侧卧或俯卧位，以腋前线、腋后线为界，将每侧肺脏分成前、侧、后三个区域，探头与肋骨垂直或平行，对双侧肺脏的每个区域进行扫查。组间比较采用Fisher′s确切概率法。结果肺出血患儿的肺超声表现主要有碎片征40例（95％），肺实变伴支气管充气征35例（83％），胸腔积液34例（81％），肺不张14例（33％）；均有胸膜线异常与A－线消失。5例患儿（12％）急性期以肺间质综合征为主要表现。对照组上述征象均未出现（ P均〈0．01），且胸膜线与A－线均清晰显示。结论肺部超声诊断肺出血准确可靠，可常规用于监护病房内新生儿肺出血的诊断。

Objective To investigate the accuracy and reliability of lung ultrasound in diagnosis of pulmonary hemorrhage of the newborn infants .Method From January 2014 to May 2016, 142 neonates from the Army General Hospital of the Chinese PLA were enrolled in the study .They were divided into two groups：a study group of 42 neonates , who were diagnosed with pulmonary hemorrhage according to their medical history, clinical manifestations and chest X-ray findings, and a control group of 100 neonates with no lung disease.All subjects underwent bedside lung ultrasound in a quiet state in a supine , lateral or prone posture, performed by a single experienced physician .The ultrasound findings were compared between the two groups.Fisher′s exact test was uesd for comparison between two groups .Result The lung ultrasound main findings associated with pulmonary hemorrhage included：（1） Shred sign：which was seen in 40 patients （95%）.（2） Lung consolidation with air bronchograms： which were seen in 35 patients （83%） .（3） Pleural effusion：which was seen in 34 infants （ 81%） , pleurocentesis confirmed that the fluid was really bleeding.（ 4 ） Atelectasis：which was seen in 14 cases （ 33%） . （ 5 ） Pleural line abnormalities and disappearing A-lines with an incidence of 100%.（6） Alveolar-interstitial syndrome：5 patients（12%）had the main manifestations of alveolar-interstitial syndrome.The above signs were not seen in normal controls （all P〉0.01） and the normal lung mainly manifested with clear pleural line and A-lines under ultrasound. Conclusion Lung ultrasonography is accurate and reliable for diagnosing pulmonary hemorrhage , which is suitable for routine application for the diagnosis of pulmonary hemorrhage in the neonatal intensive care unit.