| 摘要: |
| 目的：研究探讨肺超声评分评估新生儿呼吸窘迫综合征肺病变及预后的可行性。方法：研究对象：选择120例我院就诊且因呼吸困难而怀疑为呼吸窘迫综合征新生儿；病例收集时间：2017年9月~2018年10月。对120例呼吸困难新生儿实施肺部超声检查、胸部X线检查，以临床综合诊断结果为参照，计算和比较超声、X线在呼吸窘迫综合征诊断中的灵敏度、特异度、准确率，并分析诊断结果间的一致性。根据经腹肺分级标准和新生儿肺部超声图像，对新生儿肺部病变进行评分，比较呼吸窘迫综合征新生儿与非呼吸窘迫综合征新生儿的肺超声评分。再对呼吸窘迫综合征新生儿实施机械通气治疗和肺表面活性物质治疗，比较治疗前后患儿的肺超声评分。结果：120例呼吸困难新生儿中，有90例经临床综合诊断证实为呼吸窘迫综合征，其余30例非呼吸窘迫综合征，证实为暂时性呼吸增快症。以临床综合诊断结果为参照，超声在呼吸窘迫综合征诊断中的灵敏度、特异度、准确率均高于X线（P<0.05）。经一致性分析，X线诊断结果与临床综合诊断结果之间的一致性为中等（Kappa=0.607），而超声诊断结果与临床综合诊断结果间的一致性为良好（Kappa=0.789）。在双肺、左肺、右肺、双肺底，呼吸窘迫综合征新生儿的肺超声评分均低于非呼吸窘迫综合征新生儿（P<0.05）；治疗后，呼吸窘迫综合征新生儿各部位的肺超声评分均较治疗前增高（P<0.05）。结论：超声可对新生儿的呼吸窘迫综合征予以灵敏、准确检出，且肺超声评分还可对新生儿肺部病变及预后情况予以反映，临床上可将超声作为新生儿呼吸窘迫综合征诊断、肺病变判断、预后评估的方法。 |
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| DOI： |
| 投稿时间：2018-10-22修订日期：2020-04-07 |
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| Feasibility of evaluating pulmonary lesions and prognosis of neonatal respiratory distress syndrome with pulmonary ultrasound score |
| chengyuan |
| () |
| Abstract: |
| objective: To investigate the feasibility of evaluating pulmonary lesions and prognosis of neonatal respiratory distress syndrome (RDS) by pulmonary ultrasound. Methods: 120 neonates with respiratory distress syndrome who were admitted to our hospital and suspected to be respiratory distress syndrome were collected from September 2017 to October 2018. Pulmonary ultrasound and chest X-ray examination were performed in 120 newborns with dyspnea. The sensitivity, specificity and accuracy of X-ray in the diagnosis of respiratory distress syndrome were calculated and compared. The consistency of diagnosis results was analyzed. According to the criteria of transabdominal lung grade and the ultrasound image of the newborn lung, the pulmonary pathological changes of the newborns were evaluated, and the pulmonary ultrasound scores of the neonates with respiratory distress syndrome and those with the non-respiratory distress syndrome were compared. Mechanical ventilation and pulmonary surfactant therapy were applied to neonates with respiratory distress syndrome. Results: Of 120 newborns with dyspnea, 90 cases were confirmed as respiratory distress syndrome by clinical comprehensive diagnosis and 30 cases with non-respiratory distress syndrome, which were confirmed as temporary respiratory quickening syndrome. The sensitivity, specificity and accuracy of ultrasound in the diagnosis of respiratory distress syndrome were higher than that of X-ray (P < 0.05). The consistency analysis showed that the consistency between X-ray diagnosis and clinical comprehensive diagnosis was moderate (Kappa=0.607), while the consistency between ultrasound diagnosis and clinical comprehensive diagnosis was good (Kappa=0.789). The pulmonary ultrasound scores of neonates with double lung, left lung, right lung, double lung floor and respiratory distress syndrome were lower than those of non-respiratory distress syndrome newborns (P < 0.05), and after treatment, the lung ultrasound scores of neonates with respiratory distress syndrome were higher than those before treatment (P < 0.05). Conclusion: Ultrasound can be sensitive and accurate in detecting neonatal respiratory distress syndrome, and the pulmonary ultrasound score can reflect the pulmonary lesions and prognosis of the newborn. It can be used as a clinical diagnosis of neonatal respiratory distress syndrome. Methods for judging pulmonary lesions and evaluating prognosis. |
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