肺部超声评分对呼吸困难新生儿使用有创机械通气的预测价值

Predictive value of lung ultrasound scores for the use of invasive mechanical ventilation in neonates with respiratory distress

目的探讨肺部超声评分(LUS)对呼吸困难新生儿使用有创机械通气的预测价值。方法收集2019年6月至12月在济宁医学院附属医院产科出生的50例以呼吸困难起病的新生儿。按照使用的不同呼吸支持方式,分为有创机械通气组和无创通气组。所有患儿均在有创机械通气或无创通气前行肺部超声检查并进行评分,采用二分类Logistic回归分析呼吸困难新生儿使用有创机械通气的影响因素,并利用受试者工作曲线分析LUS对呼吸困难新生儿使用有创机械通气的预测价值。结果50例呼吸困难的新生儿中23例(46.00%)使用有创机械通气,LUS为12(10,12)分;27例(54.00%)患儿使用无创通气,LUS为7(6,11)分,差异具有统计学意义(Z=3.62,P<0.01)。LUS是呼吸困难新生儿使用有创机械通气的独立影响因素(OR=1.512,95%CI:1.168~1.958,P<0.01)。LUS预测有创机械通气的曲线下面积为0.77(95%CI:0.64~0.89,P<0.01),最佳阈值为11分,敏感度为76.50%,特异度为83.30%。结论LUS可较好地预测呼吸困难新生儿的有创机械通气需求,11分的阈值可提供最佳的敏感度和特异度。

Objective To explore the predictive value of lung ultrasound score(LUS)for the use of invasive mechanical ventilation in neonates with respiratory distress.Methods Fifty neonates with respiratory distress were enrolled in Department of Maternity,Affiliated Hospital of Jining Medical University from June to December 2019.According to different respiratory support methods,they were divided into invasive mechanical ventilation group and non-invasive ventilation group.All patients underwent lung ultrasound examination and were scored before invasive mechanical ventilation or non-invasive ventilation.The binary Logistic regression was used to explore the influential factors for the use of invasive mechanical ventilation in neonates with respiratory distress.The receiver operating characteristic(ROC)was used to explore the predictive value of LUS on the use of invasive mechanical ventilation in neonates with respiratory distress.Results Of the 50 neonates with dyspnea,23(46.00%)infants had invasive mechanical ventilation,with a median LUS of 12(10,12)points,and 27(54.00%)infants had non-invasive ventilation,with a median LUS of 7(6,11)points,and the difference was statistically significant(Z=3.62,P<0.01).LUS was an independent influential factor for mechanical ventilation in dyspnea neonates(OR=1.512,95%CI:1.168-1.958,P<0.01).The area under the curve(AUC)of LUS for predicting mechanical ventilation was 0.77(95%CI:0.64-0.89,P<0.01),the optimal threshold was 11 points,the sensitivity was 76.50%,and the specificity was 83.30%.Conclusions LUS can be utilized to predict mechanical ventilation in neonates with respiratory distress accurately.The cutoff value of 11 points provides optimal sensitivity and specificity.