肺超声评分在新生儿呼吸窘迫综合征机械通气撤离中的应用

Lung Ultrasound Score in Mechanical Ventilation Evacuation of Newborn with Respiratory Distress Syndrome

目的探讨肺超声评分(LUS)评估呼吸窘迫综合征(NRDS)新生儿机械通气成功撤离的价值。资料与方法采用回顾性研究,选取新生儿重症监护室确诊为NRDS并行有创机械通气患儿96例。拔管前进行床旁肺部超声检查,拔管后根据撤机是否成功分为成功组和失败组,比较两组LUS的差异,采用受试者工作特征曲线评价其预测拔管成功的价值。结果96例患儿中,拔管成功74例,拔管失败22例,两组年龄、性别差异无统计学意义(P>0.05)。成功组患儿撤机前LUS为(6.2±3.2)分,失败组为(14.6±2.3)分。20例(90.91%)撤机失败患儿存在肺实变或并重度肺通气减少;成功组患儿未见肺实变,4例患儿存在重度肺通气减少。LUS与动脉血氧分压呈负相关(r=-0.60,P<0.05),与动脉血二氧化碳分压呈正相关(r=0.68,P<0.05)。以LUS 10分作为成功拔管的预测值,其敏感度和特异度分别为0.95和0.82。结论床旁肺部超声评估NRDS患儿机械通气成功撤离可靠、准确,可以指导撤机。

Purpose To investigate the clinical value of lung ultrasound score(LUS)in evaluating the successful evacuation of neonatal respiratory distress syndrome(NRDS)neonates with mechanical ventilation.Materials and Methods Ninety-six NRDS neonates with invasive mechanical ventilation were retrospectively selected from neonatal intensive care unit.Before extubation,bedside pulmonary ultrasound examination was performed.After extubation,the neonates were divided into successful group and failure group according to whether the machine was successfully removed.The difference in LUS between the two groups was compared,and the value of predicting the success of extubation was evaluated by the receiver operation characteristic curve.Results For 96 cases,extubation was successful in 74 cases and failed in 22 cases,no significant difference in age or gender was observed between the two groups(P>0.05).Before evacuation,LUS in successful group and failure group was 6.15±3.23 and 14.59±2.30,respectively.In the failure group,20 cases(90.91%)had lung consolidation or severe loss of aeration;in the successful group,no lung consolidation was observed,and only 4 cases had severe loss of aeration.LUS was negatively correlated with arterial partial pressure of oxygen(r=-0.60,P<0.05)and positively correlated with arterial partial pressure of carbon dioxide(r=0.68,P<0.05).LUS 10 points as the predictive value of successful extubation,its corresponding sensitivity and specificity were 0.95 and 0.82,respectively.Conclusion Bedside lung ultrasound has reliability and accuracy to evaluate the successful evacuation of NRDS during mechanical ventilation,which can guide the evacuation.