肺部高频超声评分在新生儿呼吸窘迫综合征诊断中的应用价值

Clinical significance of pulmonary high-frequency ultrasound scoring in the diagnosis of neonatal respiratory distress syndrome

目的探讨肺部高频超声评分在诊断新生儿呼吸窘迫综合征(NRDS)中的应用价值。方法回顾性抽取2021年3月至2023年3月许昌市妇幼保健院收治的115例NRDS患儿作为NRDS组,另抽取同期50例正常新生儿作为对照组。两组新生儿于治疗前后均行肺部高频超声检测,分析两组新生儿的影像学表现,比较两组新生儿及不同病情患儿肺部高频超声评分及血气指标,进一步分析相关性及诊断价值。结果NRDS组A线消失、肺实质病变、胸膜线异常、胸腔积液、支气管充气征、弥漫性肺水肿比例均高于对照组(P均<0.05);NRDS组左肺、右肺、双肺、双侧肺评分均高于对照组(P均<0.05)。血气指标结果显示,NRDS组酸碱度(pH)值、肺泡氧分压(PaO_(2))、氧合指数(OI)均低于对照组,动脉血二氧化碳分压(PaCO_(2))高于对照组(P<0.05)。重度患儿肺部高频超声评分高于中度、轻度患儿,中度患儿肺部高频超声评分高于轻度患儿(P<0.05);重度患儿OI、PaO_(2)、pH值低于中度、轻度患儿,轻度患儿高于中度患儿(P<0.05);重度患儿PaCO_(2)高于轻度、中度患儿,轻度患儿低于中度患儿(P<0.05)。肺部高频超声评分与OI、pH值、PaO_(2)呈负相关(r=-0.54、-0.54、-0.52,P均<0.05),与PaCO_(2)呈正相关(r=0.55,P<0.05);肺部高频超声评分对NRDS的诊断曲线下面积为0.836(95%CI:0.732~0.857),P<0.05,最佳截断值为25分时,诊断灵敏度为80%,特异性为82%。结论肺部高频超声评分诊断NRDS,具有较高的诊断灵敏度、特异性,有助于评估病情,临床诊断价值较高。

Objective To investigate the clinical application value of pulmonary high-frequency ultrasound scoring in the diagnosis of neonatal respiratory distress syndrome(NRDS).Methods A total of 115 children with NRDS admitted to Xuchang Maternity and Child Health Hospital from March 2021 to March 2023 were retrospectively selected as the NRDS group,and 50 normal newborns during the same period were selected as the control group.Both groups underwent high-frequency ultrasound examination on the lungs before and after treatment,and the imaging findings of the newborns in the two groups were analyzed.The lung high-frequency ultrasound scores and blood gas indexes were compared between the two groups,and among newborns with different disease conditions.After then,the correlation and diagnostic value were further analyzed.Results The proportions of line A disappearance,parenchyma lesion,abnormal pleural line,pleural effusion,air bronchogram and diffuse pulmonary edema in the NRDS group were higher than those in the control group(all P<0.05).The scores of left lung,right lung,both lungs and bilateral lung in the NRDS group were higher than those in the control group(all P<0.05).Blood gas indexes results showed that the hydrogen ion concentration(pH)value,partial pressure of oxygen(PaO_(2))of alveolus pulmonis and oxygenation index(OI)of the NRDS group were lower than those of the control group,moreover,the arterial partial of carbon dioxide(PaCO_(2))of the NRDS group was higher than that of the control group(P<0.05).The lung high-frequency ultrasound scores in sever children were higher than those in moderate and mild children,while the moderate children had higher pulmonary high-frequency ultrasound scores than the mild children(P<0.05).The severe children had lower levels of OI,PaO_(2) and pH value compared with the moderate and mild children,while the above indicators in mild children were higher than the moderate children(P<0.05).The severe children had higher PaCO_(2) compared with the mild and moderate children,while the mild children had lower PaCO_(2) compared with moderate children(P<0.05).The lung high-frequency ultrasound score was negatively correlated with OI,pH and PaO_(2)(r=-0.54,-0.54,-0.52,all P<0.05);moreover,and it was positively correlated with PaCO_(2)(r=0.55,P<0.05).The area under the curve of pulmonary high-frequency ultrasound score in the diagnosis of NRDS was 0.836(95%CI:0.732-0.857),P<0.05,the optimal cut-off value was 25,the diagnostic sensitivity was 80%,and the specificity was 82%.Conclusions Pulmonary high-frequency ultrasound scoring has high sensitivity and specificity in the diagnosis of NRDS,which is helpful to evaluate the disease condition.