肺部超声在儿童肺炎诊断及治疗中的应用价值

The Value of Lung Ultrasound in Diagnosis and Treatment of Pneumonia in Children

目的:探讨肺部超声(LUS)对儿童肺炎(CPA)诊断和治疗效果评估的应用价值。方法:对本院门诊102例疑似肺炎的患儿行LUS和胸部X射线(CXR)检查,比较两者的诊断价值,同时对确诊入院患儿治疗前后肺部B线数量进行对比,并观察胸膜线、A线、胸膜下低回声区或肝样变区、胸腔积液的变化情况,评估治疗效果。结果:儿童肺炎的主要超声表现为胸膜线异常、多重或融合的B线、低回声区、肝样变、支气管充气征、胸腔积液。LUS诊断儿童肺炎的敏感性94.3%,特异性93.8%;CXR诊断儿童肺炎的敏感性80%,特异性90.6%,敏感性有统计学意义(χ^(2)=5.06,P<0.05),特异性无统计学意义(χ^(2)=0.00,P>0.05)。治疗后患儿肺部B线数量比治疗前明显减少,前后比较差异显著(P<0.01),LUS各项异常表现较前次均有不同程度改善。结论:在诊断儿童肺炎中LUS为可靠的辅助检查方法,其准确性不低于CXR,可作为肺炎治疗评价的依据,减少儿童在X射线下的暴露,并为疾病的发展、转归及疗效评价提供有效的信息。

Objective:To explore the value of lung ultrasound in the diagnosis and treatment of pneumonia in children.Methods:The 102 cases of suspected pneumonia in our hospital were examined by lung ultrasound and chest X-ray.The diagnostic value of the two methods was compared,at the same time,the number of B-line in the lung was compared before and after treatment,The changes of pleura line,A-line,hypoechoic area or hepatoid area under pleura,pleural effusion were observed,then the therapeutic effect was evaluated.Results:the main ultrasonic manifestations of pneumonia in children are pleura line abnormality,multiple or fused B-line,hypoechoic area,liver like change,bronchiectasis and pleural effusion.The sensitivity of LUS was 94.3%,the specificity was 93.8%,the sensitivity of CXR was 80%,the specificity was 90.6%,the sensitivity was statistically significant(χ^(2)=5.06,P<0.05),the specificity was not statistically significant(χ^(2)=0.00,P>0.05).After treatment,the number of B-line in the lungs of the children was significantly reduced compared with that before treatment(P<0.01).The abnormal indexes of LUS were improved in different degrees.Conclusions:LUS is a reliable assistant examination method in the diagnosis of pneumonia in children.Its accuracy is not less than CXR.It can be used as the basis for the evaluation of pneumonia treatment,reduce the exposure of children under X-ray,and provide effective information for the development,prognosis and efficacy evaluation of the disease.