肺超声评估新生儿肺源性呼吸窘迫的价值

Application value of lung ultrasonography in assessing neonatal pulmonary respiratory distress

摘要:

目的 应用超声及X线检查对新生儿肺源性呼吸窘迫进行评估和评分，与临床呼吸窘迫分级评分进行比较，探讨肺超声对新生儿肺源性呼吸窘迫的诊断价值，指导临床治疗。 方法 收集2021年4月—2022年11月同济大学附属第一妇婴保健院新生儿加强监护病房收治的疑似肺源性呼吸窘迫的患儿210例，均行肺部超声及X线检查，以临床最后诊断为依据，比较分析肺超声及X线检查诊断肺源性呼吸窘迫的价值，并与临床呼吸窘迫分级评分进行相关性分析。 结果 新生儿加强监护病房疑似肺源性呼吸窘迫的新生儿210例，临床最终确诊164例，肺部超声和X线检查对以上疑似病例的阳性检出率分别为71.42%、64.28%，阳性预测值分别为96.77% 、94.40%,阴性预测值分别为63.63%、53.33%, 差异均无统计学意义（P>0.05）。肺超声诊断新生儿呼吸窘迫的灵敏度、准确率均高于X线，差异有统计学意义（P<0.05），两者间特异度差异无统计学意义（P>0.05）。临床各级呼吸窘迫的肺超声评分（lung ultrasound score, LUS）比较差异均具有统计学意义（P＜0.05）。肺超声评分与临床呼吸窘迫程度呈高度正相关性，双侧肺超声总评分、右侧肺超声评分、左侧肺超声评分与呼吸窘迫临床评分呈显著线性正相关，相关系数分别为0.953、0.867和0.924。 结论 肺部超声在诊断肺源性呼吸窘迫中具有一定的应用价值，且LUS越高，呼吸窘迫程度越重，可辅助临床采用合理的呼吸支持方式，避免不当用氧影响患儿肺部发育。

Abstract:

Objectives To evaluate the application of lung ultrasonography in diagnossis of neonatal pulmonary respiratory distress. Methods A total of 210 neonates with suspected pulmonary respiratory distress admitted in NICU of Shanghai First Maternal and Infant Hospital from April 2021 to November 2022 were enrolled. All neonates underwent pulmonary ultrasound and X-ray examination. Based on the clinical diagnosis, the value of pulmonary ultrasound and X-ray examination in the diagnosis and grading of pulmonary respiratory distress was evaluated and compared. Results Among 210 suspected cases, the diagnosis of pulmonary respiratory distress was confirmed clinically in 164 cases. The positive detection rate of pulmonary ultrasound and X-ray examination was 71.42% and 64.28%, the positive predictive value was 96.77% and 94.40%, and the negative predictive value was 63.63% and 53.33%(all P>0.05). The sensitivity and accuracy of lung ultrasound in the diagnosis of neonatal respiratory distress were higher than that of X-ray(88.2% vs 79.4% and 88.1% vs 79.5%, P<0.05). There was no significant difference in specificity between the two groups(P>0.05). The degree of respiratory distress was correlated with the total bilateral lung ultrasound score, the right lung ultrasound score and the left lung ultrasound score(r=0.887, 0.781 and 0.843, P＜0.05). The clinical score of respiratory distress was positively correlated with the total score of bilateral lung ultrasound, right lung ultrasound score and left lung ultrasound score(r=0.953, 0.867 and 0.924, P＜0.05). Conclusion Lung ultrasonography has a certain application value in the diagnosis of neonatal pulmonary respiratory distress. It can assist the clinical use of reasonable respiratory support, and avoid the influence of improper use of oxygen on the lung development of children.