新生儿常见肺疾病肺脏超声检查临床分析

Point-of-care examinations of lung ultrasonography in neonatal intensive care unit

目的 研究重症监护病房（NICU）新生儿肺脏超声的特点.方法 对2014月12月1日至2015年2月28日在北京市朝阳区妇幼保健院、陆军总医院附属八一儿童医院、广东深圳宝安区妇幼保健院NICU住院的1413例无肺脏疾病及伴肺脏疾病新生儿进行肺脏超声检查.结果 1059例新生儿伴肺部疾病,354例新生儿无肺脏疾病.无肺脏疾病新生儿中,351例（99.2%）出生后3 d内、113例（31.9%）出生后3 d-1周、23例（6.5%）出生后1-2周可见B-线.在入院48 h内接受肺脏检查的491例伴肺脏疾病新生儿中,主要超声征象为A-线消失（491例,100.0%）、胸膜线异常（440例,89.6%）、肺间质综合征（353例,71.9%）、肺实变（423例,86.25%）、肺水肿（135例,27.5%）、肺搏动（96例,19.6%）等,随着病情恢复,上述征象逐渐减轻至消失.X线未能确诊的54例患儿经超声确诊为呼吸窘迫综合征（RDS）、新生儿暂时性呼吸困难（TTN）和肺炎;X线误诊为RDS的15例患儿经超声确诊为TTN;71例长期氧依赖的患儿X线未见肺水肿及肺实变等征象,但肺脏超声发现有46例存在肺不张、肺实变和/或肺间质综合征.结论 NICU新生儿肺部疾病的主要超声征象包括A-线消失、胸膜线异常、肺间质综合征、肺实变、肺水肿、肺搏动等,肺脏超声对新生儿肺疾病诊断准确.

Objective To study the features of ultrasonography （ LUS） of lung diseases in neonatal intensive care unit （ NICU） .Methods Total 1413 neonates admitted in NICU of Beijing Chaoyang District Maternal and Child Health Hospital , Bayi Children′s Hospital Affiliated to the Chinese PLA General Hospital, Shenzhen Bao′an Maternal and Child Health Hospital from December 2014 to February 2015 were included in this study .All the newborns underwent LUS examination , the ultrasonographic features of neonatal lung diseases were analyzed .Results There were 1059 cases （74.9%） with lung diseases among 1413 neonates .Among 354 neonates without lung diseases , the B-lines were observed in 351 cases （99.2%） within 3 day after birth, in 113 cases （31.9%） in 3 day to 1 week after birth, and in 23 cases in 1 to 2 weeks after birth .Among 491 neonates with lung diseases undergoing LUS examination within 48 h after admission, the A-lines disappeared in all patients; the other features included pleural lines abnormalities （n=440, 89.6%）, interstitial syndrome （n=353, 71.9%）, lung consolidation（n=423, 86.25%）, pulmonary edema （ n =135, 27.5%） and lung pulse （ n =96, 19.6%）.The reduction or elimination of above abnormal signs represented the alleviation of lung diseases .Fifty four neonates , in whom the lung diseases were not detected by X-ray, were diagnosed as transient tachypnea of newborn （TTN）, respiratory distress syndrome （RDS）and pneumonia by LUS.Fifty five patients, who were misdiagnosed with RDS by X-ray, were confirmed as TTN by LUS .Seventy one neonatal patients with long-term oxygen dependence , in whom no abnormal signs were detected by X-ray, underwent LUS examination and lung atelectasis, pulmonary consolidation and/or interstitial syndrome were diagnosed in 46 cases.Conclusion The LUS is practical and effective in diagnosis of neonatal pulmonary diseases , it is a non-irradiative diagnostic procedure and can be applied on bed side;therefore, it should be routinely used in NICU .