床旁肺脏超声诊断危重新生儿气胸的临床价值

Pneumothorax in critically ill neonates:diagnosis using bedside ultrasonography

目的探讨床旁肺脏超声(lung ultrasonography,LUS)诊断危重新生儿气胸的临床价值.方法采用前瞻性研究方法,选取2017年6月至2018年12月济宁医学院附属医院新生儿重症监护病房收治疑似气胸的危重新生儿为研究对象.纳入的患儿准备床旁LUS检查的同时,联系放射科进行床旁胸部X线检查,以胸部X线为诊断气胸的金标准.分析气胸患儿的LUS影像学特点,计算LUS诊断气胸的敏感度、特异度、阳性预测值、阴性预测值和准确度,并比较LUS和胸部X线检查耗时,观察患儿治疗转归及并发症.结果共纳入疑似新生儿气胸50例,经胸部X线诊断气胸31例(62.0%),31例患儿LUS均表现为肺滑消失、无B线和平流层征,28例(90.3%)存在肺点.LUS诊断新生儿气胸的敏感度、特异度、阳性预测值、阴性预测值、与胸部X线符合率均为100%.LUS和胸部X线检查耗时分别为(5.6±5.1)min和(20.1±12.2)min,差异有统计学意义(P<0.05).31例气胸患儿均存活,15例在LUS辅助下紧急胸腔穿刺抽气或抽气后行胸腔闭式引流,未出现术后并发症.结论LUS诊断危重新生儿气胸的准确度、敏感度及特异度高,而且操作简单,能更及时、快速地指导临床抢救.

Objective To study the value of lung ultrasonography(LUS)in the diagnosis of pneumothorax in critically ill neonates.Method The neonates admitted to our NICU and suspected to have pneumothorax were prospectively enrolled from June 2017 to December 2018.All eligible infants received both LUS examination and chest X-ray.The characteristics of LUS imaging was analyzed based on the chest X-ray which was used as the golden standard for the diagnosis of pneumothorax.The sensitivity,specificity,positive predictive value and negative predictive value of LUS is computed.The duration of LUS and chest X-ray were compared.The outcome and complications were also observed.Result Fifty neonates with suspected pneumothorax were collected.Among them,pneumothorax was confirmed with chest X-ray in 31 neonates(62.0%).Ultrasound signs of pneumothorax included absence of lung sliding(100%),absence of B lines(100%),stratosphere sign(100%)were observed in all of the 31 neonates.Presence of lung point was also observed in 90.3%of the patients.The sensitivity,specificity,positive predictive value,negative predictive value and X-ray coincidence rate of LUS in the diagnosis of pneumothorax were 100%.LUS and chest X-ray examination took(5.6±5.1)min and(20.1±12.2)min,respectively,the difference was statistically significant(P<0.05).All 31 infants with pneumothorax survived.15 infants underwent closed thoracic drainage after emergency thoracic puncture or aspiration assisted by LUS.No postoperative complications occurred.Conclusion LUS showed high accuracy,sensitivity and specificity in detecting pneumothorax in critically ill neonates.It is simple to operate and can guide clinical rescue more promptly and quickly.