新生儿肺部超声在新生儿呼吸窘迫中的诊断价值

Diagnostic Value of Neonatal Pulmonary Ultrasound in Neonatal Respiratory Distress

目的分析新生儿呼吸窘迫综合征(eonatal respiratory distress syndrome,NRDS)的超声影像学特征和肺部超声的诊断价值。方法方便选取该院于2018年7—12月期间收治的,经过临床检查、动脉血气分析检查以及胸部X线检查确诊的NRDS,以及行肺部超声检查的60例患儿为该次实验组,同时选取同时期住院的非肺病患儿29例为对照组。同常规胸部X线检查结果进行记录对比。结果①新生儿肺脏线光滑、清晰、规则以及宽度<0.05 cm;A-线清楚可见,等间距处于平行状态,>3条可见;出生后3 d或者仅有少数几条B-线(出生<3 d);无胸腔积液;肺部组织低回声;②轻度新生儿呼吸窘迫综合征主要反应为在胸膜下的局灶性肺实变,支气管充气征不显著;重度患儿肺实变范围增大,除胸膜下,累积到深部肺部组织,支气管充气征显著,所有患病患儿,肺水肿程度和肺部组织含水量有关。两组肺部超声检查结果对比,两组肺实变、胸膜线异常、A-线消失、B-线存在、肺搏动、白肺对比,差异有统计学意义(χ^2=109.000、109.000、109.000、9.793、65.533、109.000,P<0.05);③肺实变、胸膜线以及肺水肿3种征象在对RDS病症诊断中的敏感度达到100.00%,特异性也为100.00%。肺实变、胸膜线障碍、A-线消失并且同时出现时,诊断RDS的敏感度和特异度为100.00%,三种征象对比,差异有统计学意义(χ^2=48.383,P<0.05)。结论新生儿呼吸窘迫综合征的超声影像学特征诊断价值有效,其对病症的准确度高、敏感度高、特异性显著。

Objective To analyze the ultrasonographic features of neonatal respiratory distress syndrome(NRDS)and the diagnostic value of pulmonary ultrasound.Methods 60 patients who underwent clinical examination,arterial blood gas analysis and chest X-ray examination,and 60 patients with pulmonary ultrasound were enrolled in our hospital from July to December 2018.In the sub-experimental group,29 children with non-pulmonary diseases who were hospitalized at the same time were selected as the control group.The results were compared with the results of conventional chest X-ray examination.Results 1.Neonatal pleural line was smooth,clear,regular and width<0.05 cm;A-line was clearly visible,equal spacing was parallel,>3 visible;3 d after birth or only a few B-line(born<3 d);no pleural effusion;low echo of lung tissue;2.mild neonatal respiratory distress syndrome mainly reflected in the subpleural focal lung consolidation,bronchial aeration sign is not significant;severe children with lung variable range is increased,except for the subpleural effusion,which accumulates in the deep lung tissue,and the bronchial aeration sign is significant.In all the children,the degree of pulmonary edema is related to the water content of the lung tissue.The results of ultrasound examination in the two groups were compared between the two groups:lung consolidation,pleural line abnormalities,A-line disappearance,B-line presence,pulmonary pulsation,white lung contrast,and statistical significance(χ^2=109.000,109.000,109.000,9.793,65.533,109.000,P<0.05);3.The three signs of lung consolidation,pleural line and pulmonary edema were 100.00%sensitive and 100.00%specific for the diagnosis of RDS.When the lung consolidation,pleural line disorder,A-line disappeared and appeared at the same time,the sensitivity and specificity of the diagnosis of RDS was 100.00%,and the three signs were compared(χ^2=48.383,P<0.05).Conclusion The diagnostic features of neonatal respiratory distress syndrome are effective,and the accuracy,sensitivity and specificity of the disease are high.