肺部超声在小儿肺炎诊断及治疗效果动态监测中的应用效果
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摘要
目的研究肺部超声在小儿肺炎诊断及治疗效果动态监测中的应用效果。方法选择2017年4月～2018年12月在我院进行诊治的40例肺炎患儿作为研究对象,均实施X线检查、肺部超声和X线相结合方式检查。对比两种检查方式的诊断准确率,观察患儿胸部X线表现,并同时记录肺部超声检查情况。结果联合检查的诊断准确率为95.00%,高于X线检查的75.00%,差异有统计学意义(P<0.05)。入院当天进行肺超声检查,主要表现:40例患儿均出现胸膜线异常,病变部位出现A线消失,大部分患儿肺组织出现不同程度的肺实变,部分重症患儿有肺泡-间质综合征表现。肺实质出现小范围实变25例(62.50%),6～20 mm,单发实变20例,多发实变5例;其中重症肺炎患儿5例(12.50%),出现较大范围肺实变,37～75 mm,表现为胸膜下均质低回声,可动态检查到支气管充气征。治疗5～7 d后,复查超声图像多个指标出现不同程度的好转,其中恢复正常声像表现7例(17.50%),胸膜线异常17例(42.50%),仍有不同程度肺实变并局部A线消失16例(40.00%)。到患儿治愈出院时复查超声,绝大部分患儿胸膜线与A线均恢复正常,未出现明显肺实变影。结论对于小儿肺炎可采取肺部超声进行诊断,肺部超声与X线相结合检查可提高肺炎诊断准确率,治疗期间使用超声进行动态监测,通过观察胸膜线与肺实变影,能够明确患儿的治疗效果,值得应用。
Objective To study the application effect of pulmonary ultrasound in the diagnosis and dynamic monitoring of treatment effect for children with pneumonia. Methods Forty children with pneumonia who were treated in our hospital from April 2017 to December 2018 were enrolled in the study. X-ray examination, pulmonary ultrasound and X-ray examination were performed. The diagnostic accuracy of the two examination methods was compared, the chest X-ray performance of the children was observed, and the ultrasound of the lungs was recorded. Results The diagnostic accuracy rate of the combined examination was 95.00%, which was higher than the 75.00% of the X-ray examination, and the difference was statistically significant(P<0.05). On the day of admission, pulmonary ultrasonography was performed.The main manifestations were as follows, 40 cases of pleural line abnormalities occurred, and the A line disappeared in the lesions. Most of the children had different degrees of lung consolidation, and some severe cases had alveolar-interstitial syndrome performance. There were 25 cases(62.50%) of lung parenchyma, 6-20 mm, 20 cases of single-shot consolidation, and 5 cases of multiple consolidation. Among them, 5 cases(12.50%) of children with severe pneumonia had a large range of lungs, 37-75 mm, manifested as subpleural homogenous hypoechoic, dynamic examination of bronchial aeration. After 5-7 days of treatment, multiple indexes of ultrasound images were improved to different degrees, including 7 cases(17.50%) with normal sonogram and 17 cases(42.50%) with pleural line abnormalities. There were still different degrees of lung consolidation with 16 cases of the local A line disappeared(40.00%). Ultrasound was reviewed when the children were cured and discharged, most of the children′s pleural line and A line returned to normal, and no obvious lung solidity appeared. Conclusion For children with pneumonia, pulmonary ultrasound can be used for diagnosis. The combination of pulmonary ultrasound and X-ray can improve the diagnostic accuracy rate of pneumonia. Ultrasound is used for dynamic monitoring during treatment. By observing the pleural line and lung consolidation, the therapeutic effect of children can be identified, which is worthy of application.
Objective To study the application effect of pulmonary ultrasound in the diagnosis and dynamic monitoring of treatment effect for children with pneumonia. Methods Forty children with pneumonia who were treated in our hospital from April 2017 to December 2018 were enrolled in the study. X-ray examination, pulmonary ultrasound and X-ray examination were performed. The diagnostic accuracy of the two examination methods was compared, the chest X-ray performance of the children was observed, and the ultrasound of the lungs was recorded. Results The diagnostic accuracy rate of the combined examination was 95.00%, which was higher than the 75.00% of the X-ray examination, and the difference was statistically significant(P<0.05). On the day of admission, pulmonary ultrasonography was performed.The main manifestations were as follows, 40 cases of pleural line abnormalities occurred, and the A line disappeared in the lesions. Most of the children had different degrees of lung consolidation, and some severe cases had alveolar-interstitial syndrome performance. There were 25 cases(62.50%) of lung parenchyma, 6-20 mm, 20 cases of single-shot consolidation, and 5 cases of multiple consolidation. Among them, 5 cases(12.50%) of children with severe pneumonia had a large range of lungs, 37-75 mm, manifested as subpleural homogenous hypoechoic, dynamic examination of bronchial aeration. After 5-7 days of treatment, multiple indexes of ultrasound images were improved to different degrees, including 7 cases(17.50%) with normal sonogram and 17 cases(42.50%) with pleural line abnormalities. There were still different degrees of lung consolidation with 16 cases of the local A line disappeared(40.00%). Ultrasound was reviewed when the children were cured and discharged, most of the children′s pleural line and A line returned to normal, and no obvious lung solidity appeared. Conclusion For children with pneumonia, pulmonary ultrasound can be used for diagnosis. The combination of pulmonary ultrasound and X-ray can improve the diagnostic accuracy rate of pneumonia. Ultrasound is used for dynamic monitoring during treatment. By observing the pleural line and lung consolidation, the therapeutic effect of children can be identified, which is worthy of application.
引文
[1]蔡惠东,潘剑蓉.沙丁胺醇联合布地奈德氧气雾化吸入与超声雾化吸入对小儿肺炎疗效及炎症因子的改善对比探析[J].检验医学与临床,2017,14(18):2745-2747.
[2]袁鹏,李娅,张飞雪,等.肺脏超声在新生儿感染性肺炎诊断中的临床价值[J].山东大学学报(医学版),2018,56(6):29-34.
[3]农恒荣,苏楠,梁纲,等.艾滋病并发马尔尼菲青霉菌肺炎周边型病灶的超声与病理改变[J].中华传染病杂志,2015,33(4):198-201.
[4]张淑英,李银红,蒋英亮,等.中药穴位贴敷对小儿细菌性肺炎(风热闭肺型)患者WBC、CRP、IL-6的影响及疗效观察[J].中国中医急症,2015,24(9):1662-1664.
[5]任柳琼,吕发勤,冯聪,等.床旁超声在呼吸机相关性肺炎诊断中的临床应用研究[J].中华医学超声杂志(电子版),2016,13(7):542-546.
[6]查俪晶,闻卿,徐雯,等.超声造影在局灶性机化性肺炎与原发性肺癌鉴别诊断中的价值[J].中华超声影像学杂志,2018,27(8):688-691.
[7]杜博英,高健,刘春英,等.玉屏风颗粒联合复合脉冲磁疗治疗小儿肺炎恢复期肺脾气虚证的临床观察[J].临床与病理杂志,2016,36(11):1738-1743.
[8]王洪洲,祝介云,白士丽,等.小儿肺炎患儿血清CK、cTnT水平及心电图变化特征在疾病治疗及预后评价中的应用研究[J].医学综述,2016,22(9):1821-1823.
[9]冯国隽,王俊,杨红梅,等.肺部彩色多普勒超声在成人社区获得性肺炎的临床应用价值[J].重庆医学,2017,46(27):3792-3794.
[10]许庆龄.四君子汤加减联合低频超声离子导入技术治疗肺炎喘嗽的临床效果观察[J].中国实用医刊,2018,45(21):116-117,121.
[11]鲁佾,肖贞良,金梅,等.肺部超声与CT在儿童社区获得性肺炎中的对比研究[J].重庆医学,2018,47(31):3994-3997.
[12]戎群芳,张育才,徐梁,等.重症肺炎并呼吸衰竭患儿动态无创肺动脉压力监测及其意义[J].中华实用儿科临床杂志,2015,30(4):271-274.
[13]李一冰,管亚丽.床旁超声对新生儿呼吸窘迫综合征与新生儿湿肺的鉴别诊断[J].中国实用医刊,2017,44(12):114-115.
[14]李虹,李一丹,朱维维,等.超声心动图联合肺超声对呼吸困难伴肺动脉高压患者的病因诊断价值[J].中华超声影像学杂志,2016,25(10):829-833.
[15]严春苗,黄旴宁,张秋元,等.老年脑出血患者医院获得性重症肺炎的床旁超声影像特点及预后分析[J].中华医院感染学杂志,2017,27(22):5094-5097.
[2]袁鹏,李娅,张飞雪,等.肺脏超声在新生儿感染性肺炎诊断中的临床价值[J].山东大学学报(医学版),2018,56(6):29-34.
[3]农恒荣,苏楠,梁纲,等.艾滋病并发马尔尼菲青霉菌肺炎周边型病灶的超声与病理改变[J].中华传染病杂志,2015,33(4):198-201.
[4]张淑英,李银红,蒋英亮,等.中药穴位贴敷对小儿细菌性肺炎(风热闭肺型)患者WBC、CRP、IL-6的影响及疗效观察[J].中国中医急症,2015,24(9):1662-1664.
[5]任柳琼,吕发勤,冯聪,等.床旁超声在呼吸机相关性肺炎诊断中的临床应用研究[J].中华医学超声杂志(电子版),2016,13(7):542-546.
[6]查俪晶,闻卿,徐雯,等.超声造影在局灶性机化性肺炎与原发性肺癌鉴别诊断中的价值[J].中华超声影像学杂志,2018,27(8):688-691.
[7]杜博英,高健,刘春英,等.玉屏风颗粒联合复合脉冲磁疗治疗小儿肺炎恢复期肺脾气虚证的临床观察[J].临床与病理杂志,2016,36(11):1738-1743.
[8]王洪洲,祝介云,白士丽,等.小儿肺炎患儿血清CK、cTnT水平及心电图变化特征在疾病治疗及预后评价中的应用研究[J].医学综述,2016,22(9):1821-1823.
[9]冯国隽,王俊,杨红梅,等.肺部彩色多普勒超声在成人社区获得性肺炎的临床应用价值[J].重庆医学,2017,46(27):3792-3794.
[10]许庆龄.四君子汤加减联合低频超声离子导入技术治疗肺炎喘嗽的临床效果观察[J].中国实用医刊,2018,45(21):116-117,121.
[11]鲁佾,肖贞良,金梅,等.肺部超声与CT在儿童社区获得性肺炎中的对比研究[J].重庆医学,2018,47(31):3994-3997.
[12]戎群芳,张育才,徐梁,等.重症肺炎并呼吸衰竭患儿动态无创肺动脉压力监测及其意义[J].中华实用儿科临床杂志,2015,30(4):271-274.
[13]李一冰,管亚丽.床旁超声对新生儿呼吸窘迫综合征与新生儿湿肺的鉴别诊断[J].中国实用医刊,2017,44(12):114-115.
[14]李虹,李一丹,朱维维,等.超声心动图联合肺超声对呼吸困难伴肺动脉高压患者的病因诊断价值[J].中华超声影像学杂志,2016,25(10):829-833.
[15]严春苗,黄旴宁,张秋元,等.老年脑出血患者医院获得性重症肺炎的床旁超声影像特点及预后分析[J].中华医院感染学杂志,2017,27(22):5094-5097.
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