膈肌移动度与床旁超声心动图在新生儿肺炎中的应用研究

Diaphragmatic mobility and bedside echocardiography in neonatal pneumonia

目的探讨床旁超声测量膈肌移动度与床旁超声心动图评估肺动脉压力、肺血管阻力在新生儿肺炎中的应用价值。方法本研究为病例对照研究。采用非随机抽样法,选取2018年1月至2021年4月内江市第一人民医院诊治的151例新生儿肺炎患儿作为观察组,选取同期75例健康新生儿作为对照组。其中观察组根据病情程度分为轻症肺炎组(n=99)与重症肺炎组(n=52),均给予床旁超声心动图检查,对比膈肌移动度、肺动脉压力及肺血管阻力;采用受试者工作特征(ROC)曲线模型分析膈肌移动度、肺动脉压力、肺血管阻力诊断新生儿肺炎和预测新生儿肺炎严重程度的曲线下面积(AUC)值、敏感度、特异度。结果与对照组比较,观察组膈肌移动度[(0.97±0.21)cm比(0.83±0.11)cm]高(χ^(2)=5.31,P<0.001);肺动脉压力[(38.32±12.82)mmHg比(19.36±4.25)mmHg]高(1 mmHg=0.133 kPa)(χ^(2)=12.46,P<0.001);肺血管阻力[(2.57±0.63)wood比(1.87±0.25)wood]高(χ^(2)=9.26,P<0.001)。与轻症肺炎组比较,重症肺炎组膈肌移动度[(1.16±0.20)cm比(0.87±0.13)cm]高(χ^(2)=11.18,P<0.001);肺动脉压力[(52.41±9.65)mmHg比(30.92±6.52)mmHg]高(χ^(2)=16.22,P<0.001);肺血管阻力[(3.21±0.52)wood比(2.23±0.36)wood]高(χ^(2)=13.57,P<0.001)。ROC曲线分析显示,膈肌移动度、肺动脉压力、肺血管阻力诊断新生儿肺炎的AUC值分别为0.71、0.96、0.87;敏感度分别为54.30%、94.00%、75.50%;特异度分别为90.70%、93.30%、92.00%;膈肌移动度、肺动脉压力、肺血管阻力预测新生儿肺炎严重程度的AUC值分别为0.90、0.98、0.95;敏感度分别为82.70%、90.40%、90.40%;特异度分别为93.70%、97.70%、96.00%。结论床旁超声心动图评估肺动脉压力、肺血管阻力在新生儿肺炎中具有较高的应用价值,其敏感度和特异度相对高于膈肌移动度。

Objective To explore the application value of bedside ultrasound to measure diaphragmatic mobility and bedside echocardiography to assess pulmonary artery pressure and pulmonary vascular resistance in neonatal pneumonia.Methods This was a case-control study.Using the non-random sampling method,151 children with neonatal pneumonia diagnosed and treated in the First People's Hospital of Neijiang City from January 2018 to April 2021 were selected as the observation group,and 75 healthy newborns during the same period were selected as the control group.The observation group was divided into mild pneumonia group(n=99)and severe pneumonia group(n=52)according to the severity o£illness,and bedside echocardiography was performed to compare the diaphragm movement,pulmonary artery pressure and pulmonary vascular resistance.The receiver operating characteristic(ROC)curve model was used to analyze the AUC value,sensitivity and specificity of diaphragmatic muscle mobility,pulmonary artery-pressure,and pulmonary vascular resistance in diagnosing neonatal pneumonia and in predicting the severity of neonatal pneumonia.Results Compared with the control group,the movement of the diaphragm in the observation group was higher[(0.97±0.21)cm vs(0.83±0.11)cm](χ^(2)=5.31,P<0.001);pulmonary artery pres(χ^(2)=12.46,P<0.001);and pulmonary vascular resistance was higher[(2.57±0.63)wood vs(1.87±0.25)wood](χ^(2)=9.26,P<0.001).Compared with the mild pneumonia group,the diaphragm muscle mobility in the severe pneumonia group was higher[(1.16±0.20)cm vs(0.87±0.13)cm](χ^(2)=11.18,P<0.001);pulmonary artery pressure was higher[(52.41±9.65)mmHg vs(30.92±6.52)mmHg](χ^(2)=16.22,P<0.001):and pulmonary vascular resistance was higher[(3.21±0.52)wood vs(2.23 zt 0.36)wood](χ^(2)=13.57,P<0.001).ROC curve analysis showed that the AUC values of diaphragm mobility,pulmonary artery pressure,and pulmonary vascular resistance for the diagnosis of neonatal pneumonia were 0.71,0.96,and 0.87,respectively;the sensitivities were 54.30%,94.00%,and 75.50%,respectively;the specificities were 90.70%,93.30%,and 92.00%,respectively;the AUC values of diaphragm mobility,pulmonary artery pressure,and pulmonary vascular resistance for predicting the severity of neonatal pneumonia were 0.90,0.98,and 0.95,respectively;the sensitivities were 82.70%,90.40%,and 90.40%,respectively;and specificity were 93.70%,97.70%,and 96.00%,respectively.Conclusions Bedside echocardiography has a high application value in assessing pulmonary artery pressure and pulmonary vascular resistance in neonatal pneumonia,and its sensitivity and specificity are relatively higher than those of diaphragmatic muscle movement.