| 摘要: |
| 目的：比较腹部超声与X线平片在新生儿坏死性小肠结肠炎（NEC）协助诊断及预测临床转归的应用价值。方法：回顾性选择2014年2月至2019年2月我院儿科收治的80例NEC患儿，根据修正Bell-NEC分级诊断标准将患儿分为疑似组（39例）、确诊组（41例），根据临床转归分为转归良好组（内科保守治疗，50例）和转归不良组（手术治疗或死亡，30例）。均行床旁腹部超声和X线平片，收集疑似组和确诊组两种影像检查结果，比较不同临床转归患者两种检查结果的差异，分析其预测NEC患儿临床转归的价值。结果：确诊组腹部超声对肠管扩张、门静脉积气检出率分别为58.54%（24/41）、36.59% （15/41），高于腹部X线平片的36.59%（15/41）、17.07%（7/41）（P＜0.05）。转归不良组腹部X线平片腹腔游离气体、肠壁积气、门静脉积气、肠管扩张检出率分别为13.33%（4/30）、16.67%（5/30）、20.00%（6/30）、50.00%（15/30），高于转归良好组的2.00%（1/50）、2.00%（1/50）、2.00%（1/50）、24.00%（12/50）（P＜0.05），腹部超声腹腔游离气体、腹腔积液、肠壁增厚、肠管扩张检出率分别为16.67%（5/30）、50.00%（15/30）、40.00%（12/30）、50.00%（15/30），高于转归良好组的2.00%（1/50）、24.00%（12/50）、14.00%（7/50）、32.00%（16/50）（P＜0.05）。Logistic回归分析结果显示腹部超声检出腹腔游离气体、腹腔积液、肠壁增厚，腹部X线平片检出肠管扩张、腹腔游离气体是NEC患儿临床转归不良的危险因素（P＜0.05）。研究结果还显示腹部超声、腹部X线平片检查预测NEC转归不良的灵敏度分别为83.33%、63.33%，特异度分别为78.00%、72.00%。结论：与腹部X线平片比较，腹部超声对NEC患儿肠管扩张、门静脉积气有更高的检出率，可探察到NEC患儿肠道的细微变化，腹部超声在协助NEC诊断和临床转归预测中更具价值。 |
| 关键词: 腹部超声 腹部X线平片 新生儿坏死性小肠结肠炎 诊断 临床转归 |
| DOI： |
| 投稿时间：2020-04-08修订日期：2020-04-13 |
| 基金项目:广东省医学科研基金立项项目 |
|
| A comparative study of application value abdominal ultrasonography and X-ray plain film in predicting the clinical outcome of neonatal necrotizing enterocolitis in newborn |
| Wu Wei-ru,Chen Jiong-yuan |
| () |
| Abstract: |
| Objective: To explore the application value of abdominal ultrasonography and abdominal X-ray in assisting diagnosis and predicting clinical outcome of necrotizing enterocolitis (NEC) of newborn. Methods: 80 children with NEC who were admitted to our hospital from February 2015 to February 2019 were retrospectively selected. According to the revised Bell-NEC classification standard, the children were divided into suspected group (39 cases), confirmed group (41 cases), which were divided into good group (improved after conservative treatment in internal medicine, 50 cases) and bad group (operation or death, 30 cases) according to the clinical outcome. All patients were examined by X-ray and ultrasonography. The detection results of two kinds of imaging examination in the suspected group and the confirmed group were collected, and the differences of two kinds of imaging examination in the patients with different clinical outcomes were compared. The value of abdominal X-ray and abdominal ultrasound in predicting the clinical outcome of children with NEC were analyzed. Results: The detection rate of abdominal ultrasonography for intestinal dilatation and portal vein gas accumulation in the diagnosis group were 58.54%（24/41）, 36.59%（15/41），which were higher than those in the suspected group with 36.59%（15/41）, 17.07%（7/41） (P < 0.05). The detection rate of abdominal free gas, intestinal wall gas, portal vein gas and intestinal dilatation detected by abdominal X-ray in the bad group were 13.33%（4/30）, 16.67%（5/30）, 20.00%（6/30）, 50.00%（15/30）, which were higher than those in the good group with 2.00%（1/50）, 2.00%（1/50）, 2.00%（1/50）, 24.00%（12/50） (P < 0.05), and the detection rate of abdominal free gas, peritoneal effusion, intestinal wall thickening and intestinal dilatation detected by abdominal ultrasonography were 16.67%（5/30）, 50.00%（15/30）, 40.00%（12/30）, 50.00%（15/30）, which were higher than those in the good group with 2.00%（1/50）, 24.00%（12/50）, 14.00%（7/50）, 32.00%（16/50）(P < 0.05). The results of logistic regression analysis showed that abdominal free gas, ascites and thickening of intestinal wall were detected by abdominal ultrasound, and intestinal dilatation and free gas detected by abdominal X-ray film were the risk factors of poor clinical outcome of children with NEC (P < 0.05). The results also showed that the sensitivity and specificity of abdominal ultrasonography and X-ray plain film were 83.33%, 63.33% and 78.00%, 72.00% respectively. Conclusion: Compared with abdominal X-ray plain film, abdominal ultrasound has a higher detection rate for intestinal dilatation and portal vein gas accumulation in children with NEC, and can detect the subtle changes in the intestinal tract of children with NEC, which has more application value in assist diagnosis and clinical prognosis of ultrasonic signs of NEC. |
| Key words: Abdominal ultrasound Abdominal X-ray Necrotizing enterocolitis of newborn Diagnosis Clinical outcome |
