肺脏超声在我院NICU三年临床应用实践报告

Three-year clinical application practice report of lung ultrasound in our NICU

目的回顾性分析我院新生儿科肺脏超声开展3年以来的应用情况并总结其带来的临床诊疗变化.方法收集2016年5至12月(初期开展),2017年1至12月(适应期开展),2018年1至8月(成熟开展)三个阶段入住我院新生儿科,接受床旁肺脏超声检查共878例患儿的临床资料,对不同阶段的应用情况进行对比分析.结果 878 例患儿,共接受肺脏超声检查1 225 例次,存在肺疾病者64. 1%,无肺疾病者35. 9%.其中新生儿呼吸窘迫综合征67例、湿肺278例、肺炎259例、胎粪吸入综合征64例、急性呼吸窘迫综合征72例、肺不张63例、胸腔积液14例. 878例患儿共接受胸部X线检查1 122例次,患儿接受X线检查人均次数从2016年的2. 48次,下降到2017年1. 40次,2018年0. 84次.肺部CT检查共32例次,患儿接受肺CT人均检查次数从2016年的0. 060次,下降到2017年0. 038次, 2018年0. 029次.肺脏超声方便动态观察,病情的好转、加重或是新出现的肺部病灶,均可借助肺脏超声来判断.结论肺脏超声对NICU肺部疾病诊断准确,尤其对住院时间长、病情反复及撤机困难的患儿更具有实用价值,床旁易开展,能减少胸部X线和CT的人均检查次数,是NICU诊断肺部疾病有效可行的方法,值得推广.

Objective To retrospectively analyze the application of lung ultrasound in neonatal department of our hospital in the past three years, and summed up the clinical diagnosis and treatment changes brought by it. Methods The clinical data of infants accepted the bedside lung ultrasound examination from May to December 2016(early carry out stage), from January to December 2017(adaptation stage), from January to August 2018(normal conduct stage) in our NICU of Jingzhou Central Hospital were collected.The clinical data of 878 infants with different stages of application were compared and analyzed. Results In 878 children, 1 225 of lung ultrasound were performed, 64.1% of patients had pulmonary disease, and 35.9% had no lung disease.There were 67 cases of neonatal respiratory distress syndrome, 278 cases of wet lung, 259 cases of pneumonia, 64 cases of meconium aspiration syndrome, 72 cases of acute respiratory distress syndrome, 63 cases of atelectasis and 14 cases of pleural effusion.A total of 1 122 times of lung X-ray examination were performed in 878 children.The number of X-ray examinations per capita decreased from 2.48 times in 2016 to 1.40 times in 2017 and 0.84 times in 2018.A total of 32 times of pulmonary CT examination were performed.The number of lung CT inspection decreased from 0.060 times in 2016 to 0.038 times in 2017 and 0.029 times in 2018.Lung ultrasound was convenient for dynamic observation, and could be used to determine the improvement, aggravation or new pulmonary lesions. Conclusion Lung ultrasound is accurate in the diagnosis of lung disease in NICU, especially for children with long hospital stay, repeated illness and difficult to withdraw.It is easy to carry out in clinic, at the bedside, which can reduce the times of chest X-ray and CT per capita examination.Lung ultrasound is an effective and feasible method for NICU to diagnose lung diseases and it is worth promoting.