肺脏超声在新生儿肺部疾病呼吸支持治疗中的应用研究

Application Research of Lung Ultrasound in Respiratory Support Therapy For Neonatal Pulmonary Diseases

目的 观察肺脏超声在新生儿肺部疾病呼吸支持治疗中的应用效果。方法 收集2017年1月至2018年5月东莞市第八人民医院收治的新生儿91例,均因肺部疾病需进行不同程度的呼吸支持治疗,入院后均接受肺部的X线与超声检查。记录不同呼吸支持方式下的肺部X线及超声表现,进行对比分析,根据超声结果指引呼吸支持降级或撤离。结果 在91例需呼吸支持的患儿中,超声表现为未见异常9例,28例表现为肺间质水肿,有肺实变54例,其中25例表现为局灶或多发的小实变,29例患儿病情较重,超声表现为广泛的大面积实变及严重的肺间质水肿。X线表现为未见异常17例,肺纹理增粗41例,肺部斑片影或炎症渗出33例。超声诊断阳性率为90.11%,与临床诊断相符,准确率97.8%;X线阳性率79.12%,与临床诊断比较,准确率84.62%。超声与X线检查的阳性率、准确率差异有统计学意义(P<0.05)。肺实变及水肿程度越严重,越需要有创呼吸支持。当肺实变减少或消失、肺水肿减轻时,可降级或撤离呼吸支持。结论 在新生儿肺部疾病检查中,肺脏超声较X线诊断更为准确,可以根据超声变化实时评估肺部病变情况,对呼吸支持方案进行调整,指引撤离呼吸支持。同时也可减少或避免不必要的X线辐射。在新生儿肺部疾病呼吸支持治疗中,推荐肺脏超声作为首选的检查及诊断手段。

Objective To observe application of lung ultrasound in respiratory support therapy of neonatal pulmonary diseases.Methods The paper collected 91 cases neonates in our hospital from January 2017 to may 2018.All of them needed different degrees of respiratory support treatment for lung diseases.After admission,they were examined by X-ray and ultrasound,and X-ray and ultrasonic manifestations of lungs were recorded under different respiratory support modes for comparison and analysis.According to ultrasonic results,respiratory support was degraded or evacuated.Results Among 91 cases children needing respiratory support,9 cases were found no abnormality by ultrasound 28 cases showed interstitial edema of lung,54 cases of pulmonary consolidation,25 of them were focal or multiple small consolidation,29 cases were seriously ill,ultrasound showed extensive large area consolidation and severe pulmonary interstitial edema.X-ray showed 17 cases no abnormality,41 cases showed pulmonary texture thickening,33 cases showed pulmonary patch shadow or inflammation exudation,with positive rate of ultrasonic diagnosis of 90.11%,which was consistent with clinical diagnosis,with accuracy rate of 97.8%.Positive rate of X-ray was 79.12%,that of clinical diagnosis was 84.62%.There was statistical difference in positive rate and accuracy between ultrasound and X-ray examination (P<0.05).The more severe degree of pulmonary consolidation and edema,the more need for invasive respiratory support.When pulmonary consolidation is reduced or disappeared,pulmonary edema is reduced,respiratory support can be degraded or evacuated.Conclusion Pulmonary ultrasound can achievemore accurate effect than X-ray in diagnosis of neonatal pulmonary diseases,evaluate pulmonary lesions in real time according to ultrasound changes,adjust respiratory support scheme and guide evacuation of respiratory support,reduce or avoid unnecessary X-ray radiation.in respiratory support treatment of neonatal pulmonary diseases,lung ultrasound is recommended as the first choice of examination and diagnosis.