床旁肺部超声评分对呼吸窘迫患儿持续气道正压通气疗效的评估

Evaluation of the effect of bedside lung ultrasound score on continuous positive airway pressure in treatment of neonates with respiratory distress

目的探讨床旁肺部超声评分对新生儿氧合能力的评估价值,研究其在预测肺表面活性物质需求管理方面的应用价值。方法选取178例呼吸窘迫且行持续气道正压通气治疗的新生儿,根据出生时胎龄分为孕周≤37周组患儿85例和孕周>37周组患儿93例,分析肺部超声评分与氧合状态的相关性,以及其在预测新生儿肺表面活性物质应用需求中的诊断效能。结果 178例患儿床旁肺部评分中位数为16分,肺部超声评分与平均气道压(MAP)水平呈正相关(r=0.429,P<0.01);孕周>37周组与≤37周组比较,除肺部评分比较差异无统计学意义外,氧动脉分压与吸入氧浓度比值(Pa O2/Fi O2)、肺泡-动脉氧分压差、氧合指数及动脉血氧与肺泡气氧分压比值比较差异均有统计学意义(均P<0.05)。两组肺部超声评分与Pa O2/Fi O2、肺泡-动脉氧分压差、氧合指数及动脉血氧与肺泡气氧分压比值均相关(均P<0.05);ROC曲线分析显示,肺部超声评分预测孕周>37周患儿应用肺表面活性物质的临界值为12分,曲线下面积为0.793,敏感性为84.7%,特异性为57.8%;预测孕周≤37周患儿应用肺表面活性物质的临界值为15分,曲线下面积为0.931,敏感性为99.7%,特异性为62.8%。结论肺部超声评分与新生儿的氧合状态呈正相关;与孕周>37周相比,其可以更有效地预测孕周≤37周持续气道正压通气治疗早产儿应用肺表面活性物质。

Objective To investigate the value of using lung ultrasound score（LUS） in the evaluation of the oxygenation capacity of neonates in the beside,and to explore the application value of this method in predicting the need for surfactant administration. Methods A total of 178 cases of respiratory distress with treatment of continuous positive airway pressure ventilation were included. According to gestational age,there were 85 cases of neonates with gestational age ≤37 weeks and 93 cases of gestational age37 weeks groups. The correlation between LUS and oxygenation status,and its diagnostic efficacy in the prediction of the need for surfactant administration in neonates were analyzed. Results The median LUS in 178 neonates was 16,there was a significant positive correlation between LUS and mean airway pressure（r =0.429,P〈0.01）. There was no difference in LUS between gestational age ≤37 weeks and gestational age 37 weeks. However,significant correlation was found between LUS score and PaO2/FiO2,alveolar-arterial gradient,oxygenation index and arterial to alveolar ratio in gestational age≤37 weeks group and gestational age37 weeks group,there were significant difference（all P〈0.05）. There were significant differences between the two groups in terms of oxygen partial pressure and oxygen inhalation ratio,alveolar-arterial gradient,oxygenation index and arterial to alveolar ratio（all P〈0.05）. The ROC curve showed that the critical score of using pulmonary surfactant was 12 in gestational age〉37 weeks group,the area under the curve was 0.793,the sensitivity was 84.7%,the specificity was 57.8%. The critical score of using pulmonary surfactant was 15 in gestational age ≤37 weeks group,the area under the curve was 0.931,the sensitivity was 99.7%,and the specificity was 62.8%. Conclusion The LUS is positive correlated with oxygenation status in both term and preterm neonates,and compared with gestational age〉37 weeks which can be more effective in prediction of the surfactant administration in preterm babies with a gestational age less than 37 weeks under continuous positive airway pressure.