肺部超声在新生儿新型冠状病毒肺炎诊断中的应用

Application of pulmonary ultrasound in the diagnosis of COVID-19 pneumonia in neonates

目的:探讨肺部超声在新生儿新型冠状病毒肺炎(COVID-19)诊断中的应用。方法:对2020年1月31日至2月25日武汉儿童医院新生儿内科收治的5例COVID-19新生儿进行回顾性病例总结,归纳其临床资料,在入院时、病程中、出院前进行床边肺部超声检查,并与同期胸部X线片或肺部CT结果对比,观察不同检查结果间的差异。结果:5例患儿中男3例,年龄1~18日龄,临床表现主要为呼吸道和消化道症状。入院时肺部超声提示胸膜线异常(5例)、不同程度肺水肿(5例),表现为B线增多、融合,肺间质综合征,1例伴随小范围肺实变。入院时肺部CT检查表现为无明显实质浸润(2例),小条状或斑片状高密度影(2例),1例为磨玻璃样改变。病程中和出院前复查肺部超声提示超声征象均较前减轻,与同期胸部X线片结果一致。结论:新生儿COVID-19肺部超声主要表现为B线的增多、聚集,胸膜线的异常,少数有肺间质综合征及小范围肺实变。肺部超声在对肺水肿的检测上,敏感度优于胸部X线和肺部CT检查,并可对病程经过进行监测及评估。

Objective To investigate the application of pulmonary ultrasound in the diagnosis of neonatal COVID-19.Methods In this retrospective study,the clinical data of 5 infants,who were admitted to the Department of Neonatology in Wuhan Children′s Hospital from 31st January to 25th February 2020,were collected.Bedsides pulmondary ultrasound was conducted on admission,during the hospitalization,and before discharge,the result were compared with the chest X-ray or CT done at the same time.Results Among the 5 cases who aged 1-18 days,3 were male.The main clinical manifestations were respiratory and gastrointestinal symptoms.The pulmonary ultrasonography on admission showed abnormal pleural line and pulmonary edema of different severity in all 5 cases,presented as increase and fusion of B-line,and pulmonary interstitial syndrome;among them,one case also had a small-range consolidation.The chest CT on admission showed no obvious parenchymal infiltration in 2 cases,small strip or patchy high-density shadow in 2 cases,and ground glass change in one case.The re-examination of ultrosound during the hospitalization and at discharge showed improvement in all cases and were consistent with the chest X-ray taken at the same time.Conclusions The main changes on the pulmonary ultrasonography in neonates with COVID-19 pneumonia are increase and fusion of B-line,abnormal pleural line,and alveolar interstitial syndrome,and may coexist with small range of pulmonary consolidation.The sensitivity of pulmonary ultrasound is higher than that of chest X-ray and CT in the diagnosis of pulmonary edema,and could be used in monitoring and evaluation of the disease.