肺脏超声与X线在诊断呼吸窘迫症状早产儿肺疾病的对比研究

Comparison of lung ultrasonography and X-ray in the diagnosis of lung diseases of preterm infants with initial clinical manifestation of respiratory distress

目的:通过比较肺脏超声(lung ultrasonography,LUS)与X线在诊断出生后出现呼吸窘迫症状的早产儿肺脏疾病的准确性,以探讨肺脏超声在临床上的应用价值。方法:选择2017年2月至6月本院新生儿重症监护室收治的出生后即出现呼吸窘迫症状并在12 h内进行X线及床旁LUS检查的早产儿101例为研究对象,以最终的临床诊断作为金标准,分别统计X线与LUS诊断的吻合度、敏感性和特异性。结果:最终临床诊断为正常的早产儿26例,呼吸窘迫综合征(respiratory distress syndrome,RDS)61例,肺炎3例,RDS合并肺炎11例。以临床诊断为金标准,LUS的诊断吻合度高于X线(0.709比0.440)。对于发现早产儿肺脏病变,LUS的敏感性高于X线(93.3%比65.3%),但特异性低于X线(80.8%比92.3%)。其中,LUS诊断RDS敏感性高于X线(95.8%比66.7%),特异性低于X线(82.8%比96.6%);LUS诊断肺炎敏感性和特异性均高于X线(100%比98.9%,35.7%比14.3%);LUS诊断RDS合并肺炎敏感性高于X线(36.4%比9.1%),特异性与X线一致(均为100.0%)。结论:LUS在诊断新生儿呼吸窘迫疾病有独特优势,对诊断RDS、肺炎、RDS合并肺炎的敏感性均高于X线。

Objective To assess the role of lung ultrasonography(LUS)by comparing the accuracy of LUS and X-ray in the diagnosis of lung diseases of preterm infants with initial clinical manifestation of respiratory distress.Methods 101 preterm infants with initial clinical manifestation of respiratory distress in department of neonatal intensive care unit of our hospital from February to June 2017 were recruited.X-ray and LUS examination were performed bedside within 12 hours after delivery.With the final clinical diagnosis as the gold standard,the agreement coefficient of prognoses,sensitivity,and specificity of X-ray and LUS examination were calculated respectively.Results Among the 101 preterm infants,26 cases were finally clinically diagnosed as normal preterm infants,61 cases of severe respiratory distress syndrome(RDS),3 cases of pneumonia,and 11 cases of RDS plus pneumonia.With the clinical diagnosis as the gold standard,the agreement coefficient of prognoses of LUS was higher than that of X-ray(0.709 vs.0.440).For the detection of lung abnormalities in preterm infants,LUS showed a higher sensitivity(93.3%vs.65.3%)but a lower specificity(80.8%vs.92.3%)compared with X-ray.Among those lung abnormalities,LUS had a higher sensitivity(95.8%vs.66.7%)but a lower specificity(82.8%vs.96.6%)in the diagnosis of RDS compared with X-ray,LUS had both higher sensitivity(35.7%vs.14.3%)and specificity(100.0%vs.98.9%)in the diagnosis of pneumonia compared with X-ray,LUS had a higher sensitivity(36.4%vs.9.1%)and the same specificity(100.0%)in the diagnosis of RDS plus pneumonia compared with X-ray.Conclusion Because LUS has higher sensitivity in the diagnosis of RDS,pneumonia,and RDS with pneumonia compared with X-ray,we believe that it has a unique advantage in the diagnosis of neonatal respiratory distress.