应用床旁肺脏超声诊治危重新生儿气胸的临床价值研究

The Clinical Value of Bedside Pulmonary Ultrasound in the Diagnosis and Treatment of Critical Neonatal Pneumothorax

目的:探讨床旁肺脏超声在新生儿气胸中的诊断价值及其在基层医院推广的适宜性。方法:采用前瞻性研究方法,以2021年1月至2022年10月昆明市儿童医院新生儿重症监护室收治的疑似气胸的危重新生儿为研究对象,同时对其进行床旁肺脏超声检查及床旁X线检查,以临床表现为依据,比较2种方法检查结果的准确性和检查时长。结果:76例患儿中共确诊气胸66例,其中,肺脏超声确诊66例,X线确诊55例,经McNemar's和Kappa检验分析可知,2种方法诊断准确率差异有统计学意义(P<0.001),诊断结果具有中等一致性(Kappa=0.656);肺脏超声检查时长较X线检查时长短5.63 min,二者比较差异有统计学意义(P<0.001)。结论:床旁肺脏超声易学习,诊治新生儿气胸高效、便捷,优于X线摄片,适于在基层医院中推广。

Objective:To explore the diagnostic value of bedside pulmonary ultrasound in neonatal pneumothorax and its suitability for promotion in primary hospitals.Methods:A prospective study was conducted on critically ill newborns with suspected of pneumothorax admitted to the neonatal intensive care unit of Kunming Children's Hospital from January 2021 to October 2022.The enrolled patients received both bedside ultrasonography and X-ray examination.Based on clinical manifestations,the accuracy and duration of the two methods were compared.Results:A total of 66 pneumothorax cases were confirmed among the 76 cases,of which 66 cases were confirmed by pulmonary ultrasound and 55 cases were confirmed by X-ray.According to the analysis of McNemar's and Kappa tests,the difference in diagnostic accuracy between the two methods was statistically significant(P<0.001),and the diagnostic results were moderately consistent(Kappa=0.656).The duration of pulmonary ultrasound examination was 5.63 minutes shorter than that of X-ray examination,and the difference was statistically significant(P<0.001).Conclusion:Bedside pulmonary ultrasound is easy to learn,and is an efficient and convenient method for the diagnosis and treatment of neonatal pneumothorax.It is superior to X-ray imaging and is suitable for promotion in primary hospitals.