| 摘要: |
| 摘 要 目的 探讨肺动脉压力评分联合肺部超声评分早期评估早产儿支气管肺发育不良（BPD）的临床价值。方法 选取我院新生儿病房收治的169例新生儿，根据美国国立儿童健康与人类发展研究所(National Institute of Child Health and Human Development，NICHD)2001版BPD诊断标准，分为BPD组92例和非BPD组77例，均应用超声心动图检测出生后4~7 d、8~14 d、15~21 d及22~28 d肺动脉压力变化，对出生后4~28 d肺动脉压力最大值进行评分；应用肺部超声检查并评估出生后24~28 d肺部超声评分。应用单因素及多因素回归分析BPD发生的影响因素，比较两组患儿超声参数的差异，绘制受试者工作特征（ROC）曲线分析肺动脉压力评分联合肺部超声评分对BPD的早期评估效能。结果 单因素及多因素回归分析显示，肺动脉压力评分（生后4~28 d肺动脉压力最大值）、肺部超声评分（胸膜粗糙肺野数、小囊样变和横膈光滑程度）升高是BPD发生的危险因素（均P＜0.05）。BPD组与非BPD组出生胎龄、出生体质量、肺动脉压力评分、肺部超声评分及联合评分比较，差异均有统计学意义（均P＜0.05）。ROC曲线分析显示，肺动脉压力评分对BPD与非BPD患儿的区分度良好（P＜0.05），曲线下面积及其95%可信区间为0.749（0.675~0.823），截断值为1.5分；肺动脉压力联合肺部超声评分对BPD与非BPD的区分度良好（P＜0.05），曲线下面积及其95%可信区间为0.952（0.925~0.980），截断值为4分。结论 应用超声心动图可以评估早产儿出生后4~28 d肺动脉压力变化，肺动脉压力评分联合肺部超声评分在早期评估BPD中具有重要的临床价值。 |
| 关键词: 超声心动描记术 肺部超声 早产儿 支气管肺发育不良 |
| DOI： |
| 投稿时间：2022-06-26修订日期：2023-03-10 |
| 基金项目: |
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| Clinical value of pulmonary artery pressure score combined with pulmonary ultrasound score in early evaluation of bronchopulmonary dysplasia in premature infants |
| Yan Huiyuan,Shen Jieru,Sun Yinghua |
| (Children''s Hospital of Fudan University) |
| Abstract: |
| ABSTRACT Objective To explore the role of pulmonary artery pressure score combined with pulmonary ultrasound score in early evaluation of bronchopulmonary dysplasia（BPD） in premature infants.Methods A total of 169 neonatal infants admitted to the neonatal ward of our hospital from May 2016 to August 2020 were collected.，including 92 BPD and 77 non-BPD. The evaluation of the pulmonary artery pressure at 4-7，8-14，15-21，and 22-28 days and the score of the maximum pulmonary artery pressure within 4-28 days after birth were done by a senior cardiac ultrasound doctor. The lung sonography scores were completed within 24-28 days after birth by a senior ultrasonologist. The ultrasound changes in early BPD formation was analyzed by univariate and multivariate analysis. Through diagnostic test evaluation，the early evaluation value of pulmonary artery pressure score combined with pulmonary ultrasound score in bronchopulmonary dysplasia was verified. Results Both univariate and multivariate analysis showed that echocardiographic indexes（maximum pulmonary hypertension within 4-28 days after birth） and lung ultrasound indexes（rough thickening of pleura，cystic degeneration and rough diaphragm） were risk factors for BPD. And the differences were statistically significant（P＜0.05）. There were significant differences in gestational age（weeks）,birth weight（g）,pulmonary artery pressure score,pulmonary ultrasound score and combination score between BPD group and non-BPD group.Pulmonary artery pressure score can be used to early diagnose BPD（P＜0.05），AUC（95%CI） = 0.749（0.675-0.823），and pulmonary artery pressure score combined with pulmonary ultrasound score can be used to early diagnose BPD（P＜0.05），AUC（95%CI） = 0.952（0.925-0.980）. The optimal cutoff points were 1.5 for pulmonary artery pressure score and 4 for combination score.Conclusion Pulmonary artery pressure score of the maximum pulmonary artery pressure within 4-28 days after birth can be used to early diagnose BPD. The efficacy of pulmonary artery pressure score combined with pulmonary ultrasound score in early evaluation of BPD is significantly better than that of pulmonary artery pressure score alone. |
| Key words: Echocardiography Premature infants Bronchopulmonary dysplasia Lung ultrasound |
