心肺超声对胎粪吸入综合征合并持续肺动脉高压新生儿撤机结局的预测价值

The value of cardiopulmonary ultrasound in predicting withdrawal of mechanical ventilation in neonates with meconium aspiration syndrome and persistent pulmonary hypertension

目的探讨心肺超声对机械通气治疗的胎粪吸入综合征(MAS)合并持续肺动脉高压(PPHN)新生儿撤机结局的预测价值。方法回顾性分析2022年12月—2023年12月在新生儿重症监护病房实施机械通气治疗的确诊MAS合并PPHN患儿的临床资料。结果纳入患儿60例,男36例、女24例,平均胎龄(37.7±2.0)周,其中轻度肺动脉高压12例、中度肺动脉高压22例、重度肺动脉高压26例。按撤机结局分为撤机成功组42例、撤机失败组18例。撤机时,与撤机失败组相比,撤机成功组的肺部超声评分较低,肺动脉收缩压较低,左室射血分数较高,差异均有统计学意义(P<0.05)。无论撤机成功组还是撤机失败组,治疗前与撤机时之间的肺部超声评分及PaCO_(2)、PaO_(2)、氧合指数(OI),肺动脉收缩压、三尖瓣环收缩峰值位移、三尖瓣环收缩峰值速度、左室射血分数差异均有统计学意义(P<0.05)。多因素logistic回归分析发现,肺部超声评分和肺动脉收缩压升高是MAS合并PPHN患儿机械通气治疗撤机失败的独立危险因素(P<0.05),而左室射血分数升高是独立保护因素(P<0.05)。肺部超声评分、肺动脉收缩压、左室射血分数及三项指标联合预测MAS合并PPHN患儿机械通气治疗撤机失败结局的ROC曲线下面积(AUC)分别为0.85、0.76、0.75、0.93。结论心肺超声在预测MAS合并PPHN机械通气治疗患儿撤机结局中具有一定价值,临床实践中可将肺部超声评分、肺动脉收缩压、左室射血分数结合患儿临床表现进行综合评估。

Objective To investigate the value of cardiopulmonary ultrasound in predicting the withdrawal of mechanical ventilation in neonates with meconium aspiration syndrome(MAS)and persistent pulmonary hypertension of the newborn(PPHN).Methods The clinical data of patients diagnosed with MAS and PPHN who were treated with mechanical ventilation in neonatal intensive care unit from December 2022 to December 2023 were retrospectively analyzed.Results A total of 60 patients(36 boys and 24 girls)were included,and the average gestational age was(37.7±2.0)weeks.There were 12,22 and 26 cases of mild,moderate and severe pulmonary hypertension,respectively.According to the weaning outcomes,42 patients were included in the successful group and 18 were included in the failed group.When the ventilator was removed,compared with the failed group,the successful group had lower pulmonary ultrasound scores,lower pulmonary artery systolic pressure and higher left ventricular ejection fraction,with statistical significance(P<0.05).In both the successful and failed group,there were statistically significant differences in lung ultrasound scores,PaCO_(2),PaO_(2),OI,pulmonary artery systolic pressure,peak displacement of tricuspid annular contraction,peak velocity of tricuspid annular contraction,and left ventricular ejection fraction between before mechanical ventilation and the day of withdrawal(P<0.05).Multivariate logistic regression analysis showed that elevated pulmonary ultrasound score and pulmonary artery systolic pressure were independent risk factors,while elevated left ventricular ejection fraction was independent protective factor for withdrawal failure of patients with MAS and PPHN(P<0.05).The lung ultrasound score,pulmonary artery systolic pressure,left ventricular ejection fraction,and the combination of the three indicators had AUC values of 0.85,0.76,0.75,and 0.93 for the purpose of predicting withdrawal failure of mechanical ventilation in neonates with MAS and PPHN,respectively.Conclusions Cardiopulmonary ultrasound has a certain value in predicting the withdrawal of mechanical ventilation in neonates with MAS and PPHN.In clinical practice,pulmonary ultrasound score,pulmonary artery systolic pressure and left ventricular ejection fraction can be combined with clinical manifestations for comprehensive evaluation.