肺超声评分指导新生儿呼吸窘迫综合征无创呼吸机参数的探索性研究

An exploratory study on guiding significance of lung ultrasound score to noninvasive ventilator parameters in neonatal respiratory distress syndrome

目的:肺超声评分指导新生儿呼吸窘迫综合征(NRDS)无创呼吸机参数调节的价值及替代氧合的可能性。方法:选择NRDS患儿60例,进行血气分析,从初始呼气末正压(PEEP)值开始逐渐提高,根据氧合指数确定最适PEEP值,在最适PEEP值时及其前后共行3次检查,同时行肺超声评分(LUS)。通过数据采集比较,得出合适的通气评估法,指导临床PEEP的选择。结果:相关性分析显示,3个时间点测量的LUS与氧合指数均呈正相关(均P<0.001)。不同时间点比较,最适PEEP值前、最适PEEP值时及最适PEEP值后LUS与氧合指数均逐渐增加(均P<0.001)。其中各时间点LUS与氧合指数两两比较,差异均有统计学意义(均P<0.001)。结论:LUS与氧合指数具有一定的相关性,在一定程度上可替代氧合指数作为预测与评估患儿病情的重要手段,可在临床评估患儿是否达到最适PEEP值时应用。

Objective:To evaluate the value of the lung ultrasound score(LUS)in guiding the parameter regulation of neonatal respiratory distress syndrome(NRDS)ventilators and the possibility of replacing PaO2/FiO2.Methods:Sixty NRDS children were enrolled to detect blood gas analysis.The optimal value of positive end expiratory pressure(PEEP)was selected by PaO2/FiO2 method.The PEEP value and LUS was checked 3 times,before,during and after the optimal PEEP value.Through data collection and comparison,the appropriate ventilation evaluation method was obtained to guide the selection of clinical PEEP.Results:Correlation analysis showed that there was a positive correlation between LUS and PaO2/FiO2 at three measurement time points(all P<0.001).LUS and PaO2/FiO2 increased gradually at three measurement time points(all P<0.001).But there were statistical differences between LUS and PaO2/FiO2 at different measurement time points(all P<0.001).Conclusions:LUS and PaO2/FiO2 have a certain correlation and a possibility of replacing PaO2/FiO2 method,should be widely used in the evaluation for the choice of the optimal PEEP value.