| 摘要: |
| [摘要]目的 探讨肺部十四分区超声新评分法在评估新生儿呼吸窘迫综合征（neonatal respiratory distress syndrome，NRDS） 机械通气撤机时机的临床价值。方法 选取2018年6月至2019年6月我院新生儿重症监护室使用机械通气的NRDS患儿62例，在达到临床撤机标准准备拔管前进行床旁肺部超声评分（lung ultrasound score，LUS），撤机失败者于再次插管前和再次撤机前行LUS。根据结果分为撤机成功组与失败组，比较两组患儿的肺部超声评分，采用ROC曲线分析LUS对撤机时机的诊断效能。结果 62例机械通气患儿中，49例撤机成功，13例撤机失败，两组患儿LUS差异有统计学意义（P＜0.05）。失败组经肺部超声发现存在以下病变：4例明显肺水肿，5例后肺部大范围肺实变，2例肺底部大范围肺实变，1例右上肺大片肺不张，1例肺部超声未见异常（心脏彩超发现患儿心功能不全）。肺部十四分区法较其他三种方法对撤机时机有更好的诊断效能，以40.5分作为诊断界值来预测撤机失败风险，曲线下面积0.965，灵敏度92.31%，特异度93.88%。结论 肺部十四分区法对NRDS患儿机械通气撤机时机的评估具有良好的诊断价值，可早期识别撤机失败高风险患儿，进一步指导临床诊疗，提高撤机成功率。 |
| 关键词: 新生儿呼吸窘迫综合征 肺部超声 肺部十四分区评分法 机械通气 撤机时机 |
| DOI： |
| 投稿时间：2020-04-22修订日期：2021-03-04 |
| 基金项目:泉州市科技计划项目基金(编号:2018N083S) |
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| The application value of a new lung ultrasound scoring method to evaluate the timing of mechanical ventilation for neonatal respiratory distress syndrome |
| jiang qiu xia,lv guo rong,huang rong sen,shen long yuan,li xiao qing,shi li jing |
| (QuanZhou Women''s and Children’s Hospital;Quanzhou medical college maternal and child health service application technology collaborative innovation center) |
| Abstract: |
| [Abstract]: Objective: to evaluate the clinical value of the new fourteen-zone lung ultrasound scoring method in the evaluation of neonatal respiratory distress syndrome (NRDS). Method: From June 2018 to June 2019, 62 NRDS children who were mechanically ventilated in the NICU of our hospital were selected. Bedside lung ultrasound score (LUS) was performed before the patient was ready for extubation after reaching the clinical evacuation standard. LUS was administered by the withdrawal loser before re-intubation and before re-extubation. According to the results, the patients were divided into the success group and the failure group, the LUS of the two groups were compared. The ROC curve was used to analyze the diagnostic efficacy of LUS for the timing of evacuation. Results: Among the 62 children with mechanical ventilation, 49 patients were successfully removed from the machine and 13 patients were not, indicating a statistically significant difference in LUS between the two groups (P＜ 0.05). In the failure group, the following lesions were found by lung ultrasonography: 4 cases of obvious lung edema, 5 cases of extensive lung consolidation, 2 cases of extensive lung consolidation at the bottom of the lung, 1 case of large atelectasis of the upper right lung, and 1 case of no abnormality in lung ultrasonography (cardiac dysfunction was found in the children). Compared with the other three methods, the fourteen-zone lung ultrasound scoring method had a better diagnostic performance for the withdrawal time, and 40.5 point was used as the diagnostic threshold to predict the risk of withdrawal failure. The area under the curve was 0.965, the sensitivity was 92.31%, and the specificity was 93.88%. |
| Key words: Neonatal respiratory distress syndrome Lung ultrasound Fourteen-zone lung scoring Mechanical ventilate Extubation time |
