床旁超声与移动DR在新生儿重症监护室的应用比较
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摘要
目的:探讨新生儿重症监护室应用床旁超声与可移动数字化X线(Digital radiography,DR)诊断工具,对急性呼吸窘迫综合征与湿肺的鉴别诊断价值比较,以及对坏死性小肠结肠炎的诊断价值比较。方法:收集2015年1月—2017年6月于我院新生儿重症监护室住院的患儿的资料。生后24 h内出现呼吸困难患儿共80例,分析床旁超声与可移动DR对急性呼吸窘迫综合征和湿肺的鉴别诊断价值。同期临床诊断为坏死性小肠结肠炎患儿67例,对比床旁超声与移动DR对坏死性小肠结肠炎不同影像学特征的检出率。结果:床旁超声和可移动DR对急性呼吸窘迫综合征的诊断符合率都很高(93.75%和100%),但床旁超声对湿肺的诊断符合率较可移动DR高(95.35%和51.16%),差异有统计学意义(P<0.05)。床旁超声相对于可移动DR,对肠壁积气、门静脉积气、肠管扩张/肠梗阻、穿孔征象、腹腔积液、肠管发育不成熟等均具有更高的检出率,差异有统计学意义(P<0.05)。结论:新生儿重症监护室内应用床旁超声相较于可移动DR安全无创,且对湿肺有更高的鉴别诊断价值,对新生儿坏死性小肠结肠炎表现出的多种影像学特征有更高的检出率,对指导临床诊治有重要意义,值得推广。
Objective: To compare the diagnostic values of bedside ultrasound and mobile digital radiography(DR) in neonatal intensive care unit(NICU) for neonatal respiratory distress syndrome(NRDS) and wet lung, and for necrotizing enterocolitis(NEC). Methods: The newborns in NICU in our hospital from January 2015 to June 2017 were analyzed. There were 80 cases of newborns with dyspnea within 24 hours after birth. The diagnostic values of bedside ultrasound and mobile DR in NRDS and wet lung were analyzed respectively. During the same period, 67 cases of newborns with NEC were clinically diagnosed. The imaging features detection rates of NEC by bedside ultrasound and mobile DR were compared. Results: The diagnostic accordance rates of both bedside ultrasound and mobile DR in the diagnosis of NRDS were high(93.75% and 100%).However, the diagnostic accordance rate of bedside ultrasound in the diagnosis of wet lung was higher than that of mobile DR(95.35% and 51.16%), with significant difference(P<0.05). Compared with mobile DR, bedside ultrasound has higher detection rates of intestinal wall pneumatosis, portal vein pneumatosis, intestinal dilatation/intestinal obstruction, perforation signs, peritoneal effusion, immature intestinal development, and the difference was statistically significant(P<0.05). Conclusion: The application of bedside ultrasound in NICU is safer and noninvasive than that of mobile DR, and has higher differential diagnostic value for wet lung. The detection rate of various imaging features of neonatal NEC is higher, which is of great significance in guiding clinical diagnosis and treatment, and is worth popularizing.
Objective: To compare the diagnostic values of bedside ultrasound and mobile digital radiography(DR) in neonatal intensive care unit(NICU) for neonatal respiratory distress syndrome(NRDS) and wet lung, and for necrotizing enterocolitis(NEC). Methods: The newborns in NICU in our hospital from January 2015 to June 2017 were analyzed. There were 80 cases of newborns with dyspnea within 24 hours after birth. The diagnostic values of bedside ultrasound and mobile DR in NRDS and wet lung were analyzed respectively. During the same period, 67 cases of newborns with NEC were clinically diagnosed. The imaging features detection rates of NEC by bedside ultrasound and mobile DR were compared. Results: The diagnostic accordance rates of both bedside ultrasound and mobile DR in the diagnosis of NRDS were high(93.75% and 100%).However, the diagnostic accordance rate of bedside ultrasound in the diagnosis of wet lung was higher than that of mobile DR(95.35% and 51.16%), with significant difference(P<0.05). Compared with mobile DR, bedside ultrasound has higher detection rates of intestinal wall pneumatosis, portal vein pneumatosis, intestinal dilatation/intestinal obstruction, perforation signs, peritoneal effusion, immature intestinal development, and the difference was statistically significant(P<0.05). Conclusion: The application of bedside ultrasound in NICU is safer and noninvasive than that of mobile DR, and has higher differential diagnostic value for wet lung. The detection rate of various imaging features of neonatal NEC is higher, which is of great significance in guiding clinical diagnosis and treatment, and is worth popularizing.
引文
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[13]黄玉清.新生儿坏死性小肠结肠炎的发病情况及危险因素分析[J].中国妇幼保健,2017,32(14):3222-3224.
[14]Li W,Li Y,Jian L.Diagnostic value and disease evaluation significance of abdominal ultrasound inspection for neonatal necrotizing enterocolitis[J].Pak J Med Sci,2016,32(5):1251-1256.
[15]Lim JC,Golden JM,Ford HR.Pathogenesis of neonatal necrotizing enterocolitis[J].Pediatr Surg Int,2015,31(6):509-518.
[16]Sulemanji M,Vakili K,Zurakowski D,et al.Umbilical Venous Catheter Malposition Is Associated with Necrotizing Enterocolitis in Premature Infants[J].Neonatology,2017,111(4):337-343.
[17]Patel RM,Denning PW.Intestinal microbiota and its relationship with necrotizing enterocolitis[J].Pediatr Res,2015,78(3):232-238.
[2]Jacob J,Kamitsuka M,Clark RH,et al.Etiologies of NICUdeaths[J].Pediatrics,2015,135(1):e59-65.
[3]Gupta AO,Rorke J,Abubakar K.Improving the Quality of Radiographs in Neonatal Intensive Care Unit Utilizing Educational Interventions[J].Am J Perinatol,2015,32(10):980-986.
[4]Liu JM,Cao HM,Wang HM,et al.The role of lung ultrasound in diagnosis of respiratory distress syndrome in newborn infants[J].Iran J Pediatr,2014,24(2):147-154.
[5]Liu J,Chen XX,Li XW,et al.Lung Ultrasonography to Diagnose Transient Tachypnea of the Newborn[J].Chest,2016,149(5):1269-1275.
[6]冯杰雄.新生儿坏死性小肠结肠炎手术时机选择[J].中华小儿外科杂志,2015,36(2):81-82.
[7]Koyama S,Narita E,Shinohara N,et al.Effect of low-dose X-ray irradiation on micronucleus formation in human embryo,newborn and child cells[J].Int J Radiat Biol,2016,92(12):1-6.
[8]Liu J,Cao HY,Wang XL,et al.The significance and the necessity of routinely performing lung ultrasound in the neonatal intensive care units[J].J Matern Fetal Neonatal Med,2016,29(24):4025-4030.
[9]Escourrou G,Luca DD.Lung ultrasound decreased radiation exposure in preterm infants in a neonatal intensive care unit[J].Acta Paediatrica,2016,105(5):e237-e239.
[10]张瑞敏,平莉莉,刘晓红,等.新生儿呼吸窘迫综合征肺表面活性物质及呼吸支持治疗进展[J].中国妇幼保健,2016,31(16):3427-3430.
[11]Sperandeo M,Rea G,Santantonio A,et al.Lung Ultrasonography in Diagnosis of Transient Tachypnea of the Newborn:Limitations and Pitfalls[J].Chest,2016,150(4):977-978.
[12]Liu S,Tong X.The clinical comparative study of preterm respiratory distress syndrome and transient tachypnea of newborn[J].Zhonghua Er Ke Za Zhi,2015,53(2):104-108.
[13]黄玉清.新生儿坏死性小肠结肠炎的发病情况及危险因素分析[J].中国妇幼保健,2017,32(14):3222-3224.
[14]Li W,Li Y,Jian L.Diagnostic value and disease evaluation significance of abdominal ultrasound inspection for neonatal necrotizing enterocolitis[J].Pak J Med Sci,2016,32(5):1251-1256.
[15]Lim JC,Golden JM,Ford HR.Pathogenesis of neonatal necrotizing enterocolitis[J].Pediatr Surg Int,2015,31(6):509-518.
[16]Sulemanji M,Vakili K,Zurakowski D,et al.Umbilical Venous Catheter Malposition Is Associated with Necrotizing Enterocolitis in Premature Infants[J].Neonatology,2017,111(4):337-343.
[17]Patel RM,Denning PW.Intestinal microbiota and its relationship with necrotizing enterocolitis[J].Pediatr Res,2015,78(3):232-238.