床旁高频超声在早产儿感染性肺炎诊断及随访中的应用价值

Value of bedside lung ultrasound in the diagnosis of infectious pneumonia in premature infant

目的探讨床旁高频超声技术在早产儿感染性肺炎诊断及病情监测中的应用价值。方法选取临床诊断为感染性肺炎的早产患儿20例,应用高频超声进行检查,将其与胸部X线资料进行比较,在治疗第3～5天、8～10天和出院前进行肺超声监测,计算肺实变累及肋间总数及肺实变累及最大深度,比较上述参数随患儿肺部疾病进展的变化。结果⑴20例早产儿感染性肺炎肺部超声征象均出现A-线消失、肺间质综合征,19例出现肺实变伴支气管充气征(95%)、11例胸膜线异常(55%),4例出现肺滑消失(20%)、3例出现胸腔积液(15%); 20例早产儿肺炎的胸部X线征象包括肺纹理增多(100%)、斑片状磨玻璃样影(8/20,40%)、肺实变(8/20,40%)。⑵治疗期间复查肺超声,患儿肺实变累及肋间总数和累及最大深度逐渐减小至消失。结论早产儿肺炎的超声图像特征中以A-线消失、肺间质综合征、肺实变伴支气管充气征、胸膜线出现异常最为典型,肺实变征象敏感性明显高于胸部X线。床旁肺超声动态监测肺实变累及范围可用于临床评价早产儿肺炎病情进展情况。

Objective To investigate the clinical value of lung ultrasound ( LUS) in the diagnosis of infectious pneumonia in premature infant. Methods 20 premature infants with infective pneumonia were selected and examined by high-frequency ultrasound. The results were compared with chest X-ray data. Pulmonary ultrasound was monitored on the 3rd to 5th, 8th to 10th days of treatment and before discharge. The total number and maximum depth of pulmonary consolidation were calculated and the changes of the above parameters with the progression of pulmonary diseases were compared. Results The LUS imaging of 20 cases showed: A-line disappearance and pulmonary interstitial syndrome (100%), lung consolidation (95%), abnormal pleural lines (55%), interstitial syndrome (100%) and pleural effusion (15%). The X-ray of 20 cases showed: increased lung texture(100%), patchy blurred glass shadow (40%), lung consolidation(40%). The maximum depth of lung consolidation and the total number of lung consolidation involving rib clearance are decreased after therapy. Conclusions LUS is of great value in diagnosis and monitor the progresses of infectious pneumonia in premature infant, and can be used as the preferred diagnostic method in imaging.