肺部超声在羊水胎粪污染新生儿呼吸支持治疗中的指导价值

Guiding value of lung ultrasound in the treatment of neonatal respiratory support with amniotic fluid meconium contamination

目的探讨肺部超声检查在羊水胎粪污染新生儿呼吸支持治疗中的指导价值。方法回顾性选取2021年6月至2022年9月成都市郫都区妇幼保健院和成都市龙泉驿区妇幼保健院收治的羊水胎粪污染新生儿110例,依据呼吸支持治疗方法分为有创机械通气呼吸支持治疗组(有创组,重症)、无创机械通气呼吸支持治疗组(无创组,轻症)、未接受呼吸支持治疗组(未接受组,无呼吸困难)3组,分别10、50、50例。在患儿入院6 h内采用超声诊断仪对其进行肺脏超声检查,如果患儿有呼吸困难表现,则分别在呼吸支持前后6 h内接受检查,之后定期复查,每天1次,在呼吸支持撤离前2 h进行最后一次检查。比较3组患儿入院6 h内的肺部超声评分,重症组撤机成功和撤机失败患儿入院6 h内、撤机前的肺部超声评分,分析肺部超声在指导有创机械通气呼吸支持治疗中的指导价值。结果3组间肺部超声评分比较,差异有统计学意义(P<0.05),有创组患儿入院6 h内的肺部超声评分[(29.00±4.23)分]明显高于无创组[(15.02±2.14)分]和未接受组[(5.50±1.25)分],无创组患儿入院6 h内的肺部超声评分明显高于未接受组。有创组撤机成功和撤机失败患儿撤机前的肺部超声评分为(9.72±1.40)、(13.02±2.25)分,均低于入院6 h内[(27.23±4.77)、(29.75±4.63)分],差异均有统计学意义(P<0.05);入院6 h内,撤机成功和撤机失败患儿的肺部超声评分之间的差异无统计学意义(P>0.05),撤机前,撤机成功患儿的肺部超声评分明显低于撤机失败患儿,差异有统计学意义(P<0.05)。受试者工作特征(ROC)曲线分析结果显示,以18.50分为诊断界值,肺部超声评分判断羊水胎粪污染新生儿需要接受有创机械通气呼吸支持治疗的曲线下面积(AUC)为0.955(95%CI:0.905~1.000),敏感度为0.932,特异度为0.820。结论肺部超声检查对羊水胎粪污染新生儿呼吸支持治疗有较高的指导价值。

Objective To explore the guiding value of lung ultrasound in the treatment of neonatal respiratory support with amniotic fluid meconium contamination.Methods A retrospective selection was made of 110 newborns with amniotic fluid and meconium contamination admitted by Chengdu Pidu District Maternal and Child Health Hospital and Chengdu Longquanyi District Maternal and Child Health Hospital from June 2021 to September 2022,on the basis of respiration support treatment was divided into invasive mechanical ventilation support in treatment group(invasive group,severe),respiratory support noninvasive mechanical ventilation treatment group(non-invasive group,mild),no respiratory support treatment group(non-accepting group,no dyspnea)three groups,10 cases,50 cases,50 cases respectively.Lung ultrasound examination was performed on the child within 6 hours after admission.If the child had dyspnea,the child was examined within 6 hours before and after respiratory support,and then was reexamined regularly,once a day,and the last examination was performed 2 hours before the withdrawal of respiratory support.The pulmonary ultrasound scores within 6 hours after admission were compared among the three groups.The pulmonary ultrasound scores within 6 hours after admission and before weaning were compared between the children in the critical group who were weaning successfully and those who were weaning failed,and the guiding value of pulmonary ultrasound in guiding invasive mechanical ventilation and respiratory support treatment was analyzed.Results There was statistically significant difference in lung ultrasound scores among the three groups(P<0.05),the lung ultrasound scores[(29.00±4.23)points]of children in the invasive group within 6 hours after admission were significantly higher than those in the non-invasive group[(15.02±2.14)points]and the non-accepting group[(5.50±1.25)points],and the pulmonary ultrasound scores within 6 hours after admission in the non-invasive group were higher than those in the non-acceptance group.In the invasive group,the pulmonary ultrasound scores of children with successful and failed weaning were(9.72±1.40)and(13.02±2.25)points before weaning,which were lower than those within 6 hours of admission[(27.23±4.77)and(29.75±4.63)points];within 6 hours after admission,there was no significant difference in the pulmonary ultrasound score between the children who succeeded in weaning and those who failed in weaning(P>0.05);before weaning,the pulmonary ultrasound scores of the children who succeeded weaning were lower than those of the children who failed weaning,the differences were statistically significant(P<0.05).The results of receiver operating characteristic(ROC)curve analysis showed that and the diagnostic threshold was 18.50,the area under the curve(AUC)of newborn infants with amniotic fluid meconium contamination who needed invasive mechanical ventilation and respiratory support was 0.955(95%CI:0.905-1.000),sensitivity was 0.932,specificity was 0.820.Conclusion Pulmonary ultrasound examination has a high guiding value in the treatment of neonatal respiratory support with amniotic fluid meconium contamination.