床旁肺部超声在新生儿感染性肺炎中的应用价值

Application value of bedside pulmonary ultrasound in neonatal infectious pneumonia

目的:系统性分析新生儿感染性肺炎的肺部超声特征及其应用价值。方法:收集完善肺部超声检查的564例新生儿感染性肺炎患者,对其临床资料、肺部超声资料特点进行回顾性分析。结果:共纳入新生儿感染性肺炎564例,平均胎龄(36.87±3.56)周;平均出生体重(2810.59±810.28)g;平均住院时间(16.56±13.42)d。其中,59.22%(334/564)患儿需要呼吸机使用;27.66%(156/564)患儿需要肺表面活性物质。新生儿感染性肺炎肺部超声声像图以肺泡间质综合征和异常胸膜线为主,发生比例分别为67.73%和67.38%;肺通气评分的平均值为(11.41±6.96)分,呼吸机使用组的肺通气评分高于未使用组[(16.32±6.275)vs.(7.21±4.967),P=0.001]。肺部超声评分预测感染性肺炎患儿是否需要使用呼吸机的ROC曲线下面积为0.864(P<0.05),肺部超声最佳界值为11.50分,敏感性为0.797,特异性为0.814。肺表面活性物质使用组肺通气评分高于未使用组[(19.65±5.305)vs.(8.96±6.142),P=0.001)]。肺部超声评分预测感染性肺炎患儿是否需要使用肺表面活性物质的ROC曲线下面积为0.886(P<0.05),肺部超声评分最佳界值为16.50分,敏感性为0.883,特异性为0.851。结论:新生儿感染性肺炎的肺部超声声像图像具有特征性,且肺通气评分在临床肺表面活性物质以及呼吸机的使用中有指导价值。

Objective:To explore the lung ultrasound findings and the application value in neonatal infectious pneumonia.Methods:564 cases of neonatal infectious pneumonia were collected,and the clinical data and characteristics of pulmonary ultrasound were analyzed retrospectively.Results:A total of 564 cases of neonatal infectious pneumonia were included in the study,with the average gestational age of 36.87±3.56 weeks,with the average birth weight of 2810.59±810.28 grams,with the average hospital stay of 16.56±13.42 days.Of which 59.22%(334/564)infants were supported by ventilation and 27.66%(156/564)infants were required pulmonary surfactant(PS).The main pulmonary ultrasound findings of neonatal infectious pneumonia were alveolar interstitial syndrome(AIS)and abnormal pleural lines,with the incidence of 67.73%and 67.38%,respectively.The mean pulmonary ultrasound scores(LUS)was 11.41±6.96 points.LUS in groups with ventilation support was higher than groups without ventilation support(16.32±6.275 vs.7.21±4.967,P=0.001).The area under ROC curve for LUS to predict the PS requirement was 0.864(P<0.05),and the best cutoff value of LUS was 11.50 the sensitivity 0.797,and specificity 0.814;LUS in groups with using pulmonary surfactant was higher than groups without using pulmonary surfactant(19.65±5.305 vs.8.96±6.142,P=0.001).The area under ROC curve for LUS to predict the PS requirement was 0.886(P<0.05),and the best cutoff value of LUS was 16.50 with the sensitivity 0.833,and specificity 0.851.Conclusion:The pulmonary ultrasound sonograms of neonatal infectious pneumonia are characteristic,and LUS has the high capacity to guide the management of severe neonatal pneumonia in clinical practice.