腹部超声在新生儿坏死性小肠结肠炎中的应用价值分析

Application value of bedside ultrasound in neonatal necrotizing enterocolitis

目的通过评估腹部超声在新生儿坏死性小肠结肠炎(NEC)诊断及治疗中的效果,探讨其在NEC中的应用价值。方法选取2018年9月~2020年6月经影像学辅助确诊为NEC的74例新生儿作为研究对象,所有患儿均行X线腹部平片确诊为NEC后,于4h内行腹部超声检查,将患儿根据辅助检查方式分为X线组和超声组,根据治疗方式将患儿分为内科组及外科组,通过对比腹部X线与腹部超声的影像学结果及治疗效果,明确腹部超声在NEC中的应用价值。结果两组经影像学确诊的患儿,一般资料对比差异无统计学意义(P>0.05);两组患儿影像学特点,结果提示差异有统计学意义(P<0.05),且超声对于特异性表现的总体检出率更高;手术组对于特异性的检出率均≥内科组,差异有统计学意义(P<0.05);以X线平片及床旁超声检出肠壁增厚、肠管扩张、肠壁积气、门静脉积气等为自变量,构建Logistics回归分析模型,腹部超声对于门静脉积气、肠壁积气、腹腔积液、肠壁增厚,X线平片检出肠壁积气、肠壁增厚均为NEC患儿外科手术的重要影响因素(P<0.05)。结论腹部超声对于NEC的诊断及治疗有辅助作用,值得临床推广应用。

Objective To evaluate the effect of abdominal ultrasound in the diagnosis and treatment of neonatal necrotizing enterocolitis, and to explore the application value of abdominal ultrasound in NEC.Methods From September 2018 to June 2020,74 newborns who were admitted to the Affiliated Hospital of Weifang Medical University and Weifang Maternal and Child Health Hospital and were diagnosed as NEC with the help of imaging were selected as the research objects.After all the children were diagnosed as NEC by X-ray plain film, they were examined by abdominal ultrasound within 4 hours.The children were divided into X-ray group and ultrasound group according to the auxiliary examination methods.According to the treatment methods, the children were divided into internal medicine group and surgical group.By comparing the imaging results and treatment effects of abdominal X-ray and abdominal ultrasound, to determine the application value of abdominal ultrasound in NEC.Results There was no significant difference in general data between the two groups of children diagnosed by imaging(P>0.05).The results of the imaging characteristics between the two groups suggested that the difference was statistically significant(P<0.05).In addition, the overall detection rate of specific manifestations by ultrasonography was higher.The specific detection rates in the operation group were not less than that in the internal medicine group, and the difference was statistically significant(P<0.05).The Logistics regression analysis model was constructed with the detection of intestinal wall thickening, intestinal dilatation, intestinal wall gas accumulation, and portal vein gas accumulation by plain X-ray and bedside ultrasound as independent variables.The detection of intestinal wall gas accumulation and thickening by abdominal ultrasound were all important influencing factors for the surgery of children with NEC(P<0.05).Conclusion Abdominal ultrasound plays an important auxiliary role in the diagnosis and treatment of NEC,which is worth promoting.