肺部超声在早产儿肺部疾病中的应用

Application of lung ultrasound in premature infants with pulmonary disease

目的探讨肺部超声在早产儿常见肺部疾病诊治过程中的应用效果,减少早产儿暴露放射线损伤的风险。方法临床观察患有肺部疾病的73例早产儿,以及60例无肺部疾患的早产儿,两组早产儿均进行床旁肺部超声检查,病例组尚接受X线胸片或CT检查,并在肺部疾病好转后适时复查肺部超声,观察两组早产儿不同的肺部超声表现。结果肺实变伴支气管充气征是早产儿肺炎最主要的超声影像学改变;A-线消失见于所有新生儿呼吸窘迫综合征(NRDS)患儿,肺实变亦是NRDS重要的指标;胸膜线异常见于所有肺出血的早产儿中。肺部超声对肺炎诊断的准确度、特异度与灵敏度分别为91.78%(67/73)、81.82%(18/22)、96.08%(49/51);对NRDS诊断的准确度、特异度与灵敏度分别为93.15%(68/73)、94.74%(36/38)、91.43%(32/35);对肺出血诊断的准确度、特异度与灵敏度分别为97.26%(71/73)、98.41%(62/63)、90.00%(9/10)。X线与肺部超声在诊断早产儿肺炎和NRDS准确度上的比较差异无统计学意义(P>0.05);在早产儿肺出血的诊断准确度上比较差异有统计学意义(P<0.05)。结论肺部超声作为一种重要的检查和监测手段,对早产儿肺部疾病的诊断具有其灵敏度和特异性,可作为早产儿肺部疾病的影像学检查方法,安全性较高,值得临床推广。

Objective To investigate the effect of lung ultrasound in the diagnosis and treatment of common pulmonary diseases in premature infants,so as to reduce the risk of exposure to radiation.Methods Clinical observation was performed on 73 premature infants with pulmonary diseases and 60 infants without pulmonary diseases.All the premature infants in both groups underwent bedside lung ultrasound examination,while the case group also received X-ray chest radiograph or CT examination and timely lung ultrasound reexamination after the alleviation of pulmonary diseases.Different pulmonary ultrasonographic manifestations were observed in the two groups of premature infants.Results Lung consolidation accompanied by air bronchogram was the most important ultrasonographic change in premature infants with pneumonia.The disappearance of A-lines was observed in all children with neonatal respiratory distress syndrome(NRDS),and lung consolidation was also an important indicator for NRDS.Abnormal pleural lines were found in all premature infants with pulmonary hemorrhage.The accuracy,specificity and sensitivity of lung ultrasound in the diagnosis of pneumonia were 91.78%(67/73),81.82%(18/22)and 96.08%(49/51)respectively.The accuracy,specificity and sensitivity of lung ultrasound in the diagnosis of NRDS were 93.15%(68/73),94.74%(36/38)and 91.43%(32/35),respectively.The accuracy,specificity and sensitivity of lung ultrasound in the diagnosis of pulmonary hemorrhage were 97.26%(71/73),98.41%(62/63),90.00%(9/10).There was no statistically significant difference between X-ray and lung ultrasound in the diagnosis accuracy of premature pneumonia and NRDS(P>0.05).There were statistically significant differences between X-ray and pulmonary ultrasound in the diagnosis accuracy of pulmonary hemorrhage in premature infants(P<0.05).Conclusion As an important means of examination and monitoring,lung ultrasound has its sensitivity and specificity in the diagnosis of pulmonary diseases in premature infants.It can be used as an imaging examination method for pulmonary diseases in premature infants.And it is safe and worthy of clinical promotion.