便携式彩色多普勒超声诊断仪对新生儿重症监护病房患儿肺不张的诊断研究

Study on the Diagnosis of Pulmonary Atelactasis in Neonatal Intensive Care Unit with Portable Color Doppler Ultrasonic Diagnostic Instrument

目的研究便携式彩色多普勒超声诊断仪对新生儿重症监护病房(Neonatal Intensive Care Unit,NICU)患儿肺不张(Pulmonary Atelactasis,PA)的诊断价值。方法使用便携式彩色多普勒超声诊断仪对174例NICU住院患儿行双肺超声检查,观察PA情况,根据临床诊断对PA的发病特点进行统计学分析。结果174例患儿共检出PA 43例(24.71%):呼吸窘迫综合征(Respiratory Distress Syndrome,RDS)19例(44.19%),RDS并感染性肺炎(Infectious Pneumonia,IPN)1例(2.33%),早产高危随访患儿2例(4.66%,曾患RDS),IPN 5例(11.63%),支气管肺发育不良(Bronchopulmonary Dysplasia,BPD)2例(4.66%),RDS并BPD 8例(18.60%),IPN并BPD 2例(4.66%),非呼吸道疾病4例(9.30%)。早产儿PA发生率高于足月儿(P=0.000);未行气管插管、气管插管+肺表面活性剂治疗及气管插管+机械通气患儿在是否发生PA方面差异有统计学意义(P=0.000)。两两比较,未行气管插管患儿发生率低于后两组,气管插管+肺表面活性剂治疗与气管插管+机械通气两组间无明显差异。动脉导管未闭(Patent Ductus Arteriosis,PDA)和/或室缺(Ventricular Septal Defect,VSD)患儿PA发生率高于不存在上述病变患儿(P=0.016)。结论便携式彩色多普勒超声诊断仪对NICU内患儿PA的诊断、随访具有较高临床应用价值。NICU患儿PA发生率较高,多见于早产儿,与气管插管、PDA、VSD关系密切,RDS是其首要病因,亦可见于非呼吸道疾病患儿。

Objective To investigate the diagnosis value of portable color doppler ultrasonic diagnostic instrument in pulmonary atelactasis(PA)in neonatal intensive care unit(NICU).Methods Ultrasound were performed on 174 neonatals’lung using portable color doppler ultrasonic diagnostic instrument in NICU.According to clinical diagnosis,the incidence characteristics of PA were statistically analyzed.Results There were 43 neonatals(24.71%)with PA of 174:19 cases(44.19%)were with respiratory distress syndrome(RDS);1 case(2.33%)neonatal was with RDS and infectious pneumonia(IPN);2 cases(4.66%)were follow-up of high risk children(suffered RDS);5 cases(11.63%)were with IPN;2 cases(4.66%)were with bronchopulmonary dysplasia(BPD)8 cases(18.60%)were with RDS and BPD;2 cases(4.66%)were with IPN and BPD;4 cases(9.30%)were non-respiratory diseases.The morbidity rate of PA in premature neonatal was higher than that in termneonatal(P=0.000).There was a significant difference about PA in non trachea intubation,tracheal intubation+pulmonary surfactant and trachea intubation+mechanical ventilation(P=0.000).Comparing the two,the morbidity rate of PA in non trachea intubation was lower than that in trachea intubation+pulmonary surfactant,trachea intubation+mechanical ventilation.There was not a significant difference between trachea intubation+pulmonary surfactant and trachea intubation+mechanical ventilation.The morbidity rate of PA in neonatals with patent ductus arteriosis(PDA)and/or ventricular septal defect(VSD)was higher than that who without that(P=0.016).Conclusion The portable color doppler ultrasonic diagnostic instrument has high value in diagnosis and follow-up PA in NICU.The incidence rate of PA is higher and more common in preterm neonatal in NICU.It’s closely related with trachea intubation,PDA,VSD.The RDS is the primary cause.It is also found in infants with non-respiratory diseases.