床边肺脏超声评估鼻腔持续正压通气与肺表面活性物质治疗NRDS的临床价值

Clinical value of bedside pulmonary ultrasound in evaluating the efficacy of nasal continuous positive airway pressure and pulmonary surfactant in the treatment of NRDS

目的探讨床边肺脏超声对接受鼻腔持续正压通气与肺表面活性物质治疗的新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)患儿的评估价值。方法132例NRDS早产儿应用肺表面活性物质和鼻腔持续正压通气(NCPAP)治疗,在患儿治疗前后进行肺脏超声及胸部X线检查,比较检查结果,并通过Kappa法比较两种检查方法对NRDS患儿治疗前、后病情评估的一致性。结果治疗前和治疗后,NRDS患儿LUS评分分别为(12.74±3.06)分、(6.93±1.25)分,两者差异有统计学意义(t=20.194,P<0.001);治疗后胸部X线分级Ⅰ/Ⅱ级占比(73.48%)较治疗前(54.55%)增加,差异有统计学意义(χ^(2)=10.277,P=0.001)。LUS评分及胸部X线分级对患儿治疗前、后病情的评估结果具有一致性(Kappa=0.834、0.737,均P<0.001)。结论床边肺脏超声检查可有效评估NRDS患儿治疗前后的病情变化,在临床上可替代胸部X线用于NRDS诊疗评估。

Objective To explore the value of bedside lung ultrasound in evaluating the pediatric patients with neonatal respiratory distress syndrome(NRDS)treated with nasal continuous positive airway pressure and pulmonary surfactant.Methods 132 premature infants with NRDS were treated with pulmonary surfactant and nasal continuous positive pressure(NCPAP).The pediatric patients received lung ultrasound and chest X-ray examinations before and after treatment.The results were compared,and the consistency of the two examination methods in evaluating the condition of pediatric patients with NRDS before and after treatment was compared by Kappa method.Results Before and after treatment,LUS scores of children with NRDS were(12.74±3.06)points and(6.93±1.25)points,respectively,and the difference was statistically significant(t=20.194,P<0.001).After treatment,the proportion of chest X-ray classⅠ/Ⅱ(73.48%)increased compared with that before treatment(54.55%),and the difference was statistically significant(χ^(2)=10.277,P=0.001).There was a consistency between the results of LUS score and chest X-ray classification in the evaluation of the condition of pediatric patients before and after treatment(Kappa=0.834,0.737,all P<0.001).Conclusions Bedside lung ultrasonography can effectively evaluate the changes of the condition of children with NRDS before and after treatment,and can replace chest X-ray in the evaluation of clinical diagnosis and treatment of NRDS.