床旁肺脏超声对新生儿宫内感染性肺炎的诊断价值

The role of lung ultrasonography in the diagnosis of neonatal intrauterine infectious pneumonia

目的探讨床旁肺脏超声(lung ultrasonography,LUS)对新生儿宫内感染性肺炎的诊断价值。方法采用前瞻性研究方法,选取新生儿监护室收治的有宫内感染高危因素,生后48 h内出现呼吸困难的新生儿为研究对象,对患儿进行LUS及胸部X线检查,观察LUS影像学征象,分析床旁LUS诊断新生儿宫内感染性肺炎的敏感度、特异度、阳性预测值、阴性预测值、准确度,并与胸部X线检查结果进行比较。结果共纳入呼吸困难新生儿106例。根据最终临床诊断将纳入患儿分为肺炎组和非肺炎组。两组患儿肺实变伴支气管充气征比较,肺炎组明显高于非肺炎组,差异有统计学意义(P<0.05)。两组患儿A线消失、胸膜线异常、多量B线比较,差异无统计学意义(P>0.05)。LUS诊断新生儿宫内感染性肺炎的敏感度89.4%,特异度52.5%,阳性预测值75.6%,阴性预测值75.0%,准确度75.5%。胸部X线诊断新生儿宫内感染性肺炎的敏感度90.9%,特异度45.0%,阳性预测值73.2%,阴性预测值75.0%,准确度73.6%。两者在敏感度、特异度、阳性预测值、阴性预测值、准确度比较差异无统计学意义(P>0.05)。结论与胸部X线相比,LUS对新生儿宫内感染性肺炎具有重要的诊断价值,而且更直观、快速、无辐射。

Objective To determine the accuracy of lung ultrasonography ( LUS) for the diagnosis of neonatal intrauterine infectious pneumonia. Methods A prospective cohort study was performed. The neonates with high risk for intrauterine infection,who had respiratory distress within 48 h after birth. All neonates underwent LUS examination and chest X-ray. The images of LUS were stored and analyzed. The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of LUS for the diagnosis of neonatal intrauterine infectious pneumonia was performed, and compared with chest X-ray. Results A total of 106 neonates with dyspnea were studied. According to the final clinical diagnosis,the neonates were divided into pneumonia group and non-pneumonia group. The comparison of pulmonary consolidation with bronchopneumatic sign between the two groups showed that it was significantly higher in the pneumonia group than the non-pneumonia group ( P < 0. 05). There was no statistically significant difference between the two groups in the disappearance of A line,abnormal pleural line or multiple B line ( P > 0. 05). LUS had a sensitivity of 89. 4%, specificity of 52. 5%,positive predictive value of 75. 6%,negative predictive value of 75. 0% and accuracy of 75. 5% in the diagnosis of neonatal intrauterine infectious pneumonia. The sensitivity,specificity,positive predictive value and negative predictive value of chest X-ray for neonatal intrauterine infective pneumonia were 90. 9%,45. 0%,73. 2%, 75. 0% and 73. 6%,respectively. There was no significant difference in sensitivity,specificity,positive predictive value, negative predictive value or accuracy for the diagnosis of neonatal intrauterine infectious pneumonia between LUS and chest X-ray ( P > 0. 05). Conclusion LUS has important diagnostic value in neonatal intrauterine infective pneumonia.