高频肺部超声在新生儿肺炎诊断中应用价值分析
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摘要
目的探讨高频肺部超声诊断新生儿肺炎的价值。方法我院儿科收治200例新生儿进行肺部超声扫描,根据临床诊断结果将新生儿分为肺炎组和非肺炎组,对比两组肺部超声特征差异,对肺炎患儿进行超声肺部(LUS)评分,分析LUS评分与血气结果 (PCO_2、PO_2、pH值、SO_2)的相关性,利用ROC分析高频超声对新生儿肺炎的诊断价值。结果肺炎新生儿65例,非肺炎组新生儿135例,肺炎新生儿肺部超声以胸膜线模糊增厚、粗糙不平、肺滑动征消失、多发典型B线、多发融合B线为特征,且多合并胸膜下实变、胸腔积肺不张、气胸等表现。LUS评分与PCO_2呈正相关(r=0.651,P<0.05),与PO_2、pH值、SO_2呈负相关(r=-0.735、-0.498、-0.726,P<0.05)。高频超声诊断新生儿肺炎灵敏度、特异度、阳性预测值、阴性预测值分别为92.31%、92.59%、85.71%、96.15%,利用ROC分析高频超声诊断新生儿肺炎曲线下面积(AUC)为0.869 (95%CI:0.765～0.973,P=0.000)。结论高频肺部超声诊断新生儿肺炎灵敏度、特异度高,结合LUS评分对新生儿肺炎诊断和治疗有一定指导价值。
Objective To investigate the value of high-frequency pulmonary ultrasound in the diagnosis of neonatal pneumonia.Methods 200 babies from the Nanjing Gulou Hospital Group Suqian People′s Hospital underwent pulmonary ultrasound scan.According to the clinical diagnosis,the newborns were divided into pneumonia group and pneumonia group.The differences of pulmonary ultrasound characteristics between the two groups were compared children with pneumonia were graded by ultrasound lung(LUS),the correlation between LUS score and blood gas results(PCO_2,PO_2,pH,SO_2),The diagnostic value of high-frequency ultrasound in neonatal pneumonia was arahped by ROC.Results There were 65 children in the pneumonia group and 135 in non-pneumonia newborns.The pulmonary ultrasound in neonates with pneumonia was characterized by blurred thickening and rough unevenness of pleural line,disappearance of lung slip sign,multiple typical B lines,multiple fusion B lines,and more combined with subpleural consolidation,pleural atelectasis,pneumothorax and other performance.The LUS score was positively correlated with PCO_2(r=0.651,P<0.05),and negatively correlated with PO_2,pH value and SO_2(r=-0.735,-0.498,-0.726,P<0.05).The sensitivity,specificity,positive predictive value and negative predictive value of high-frequency ultrasound diagnosis of neonatal pneumonia were 92.31%,92.59%,85.71%,and 96.15%,respectively.The area under the curve(AUC)of high-frequency ultrasound diagnosis of neonatal pneumonia was 0.869(95% CI:0.765～0.973,P=0.000)by ROC analysis.Conclusions High-frequency pulmonary ultrasound has high sensitivity and specificity in the diagnosis of neonatal pneumonia,it has a certain guiding value in the diagnosis and treatment of neonatal pneumonia combined with LUS score.
Objective To investigate the value of high-frequency pulmonary ultrasound in the diagnosis of neonatal pneumonia.Methods 200 babies from the Nanjing Gulou Hospital Group Suqian People′s Hospital underwent pulmonary ultrasound scan.According to the clinical diagnosis,the newborns were divided into pneumonia group and pneumonia group.The differences of pulmonary ultrasound characteristics between the two groups were compared children with pneumonia were graded by ultrasound lung(LUS),the correlation between LUS score and blood gas results(PCO_2,PO_2,pH,SO_2),The diagnostic value of high-frequency ultrasound in neonatal pneumonia was arahped by ROC.Results There were 65 children in the pneumonia group and 135 in non-pneumonia newborns.The pulmonary ultrasound in neonates with pneumonia was characterized by blurred thickening and rough unevenness of pleural line,disappearance of lung slip sign,multiple typical B lines,multiple fusion B lines,and more combined with subpleural consolidation,pleural atelectasis,pneumothorax and other performance.The LUS score was positively correlated with PCO_2(r=0.651,P<0.05),and negatively correlated with PO_2,pH value and SO_2(r=-0.735,-0.498,-0.726,P<0.05).The sensitivity,specificity,positive predictive value and negative predictive value of high-frequency ultrasound diagnosis of neonatal pneumonia were 92.31%,92.59%,85.71%,and 96.15%,respectively.The area under the curve(AUC)of high-frequency ultrasound diagnosis of neonatal pneumonia was 0.869(95% CI:0.765～0.973,P=0.000)by ROC analysis.Conclusions High-frequency pulmonary ultrasound has high sensitivity and specificity in the diagnosis of neonatal pneumonia,it has a certain guiding value in the diagnosis and treatment of neonatal pneumonia combined with LUS score.
引文
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[2]MONGODI S,VIA G,GIRARD M,et al.Lung ultrasound for early diagnosis of ventilator-associated pneumonia[J].Chest,2016,149(4):969-980.
[3]MADSEN P H,HESS S.Symptomatology,clinical presentation and basic work up in patients with suspected pulmonary embolism[J].Adv Exp Med Biol,2017,906:33-48.
[4]HADDAM M,ZIELESKIEWICZ L,PERBET S,et al.Lung ultrasonography for assessment of oxygenation response to prone position ventilation in ARDS[J].Intensive Care Med,2016,42(10):1546-1556.
[5]周晓玉.感染性肺炎[M]//邵肖梅,叶鸿瑁,丘小汕.实用新生儿学.4版.北京:人民卫生出版社,2011:401-408.
[6]PEREDA M A,CHAVEZ M A,HOOPER-MIELE C C,et al.Lungultrasound for the diagnosis of pneumonia in children:a metaanalysis[J].Pediatrics,2015,135(4):714-722.
[7]BRAT R,YOUSEF N,KLIFA R,et al.Lung Ultrasonography Score to Evaluate Oxygenation and Surfactant Need in Neonates Treated With Continuous Positive Airway Pressure[J].Jama Pediatrics,2015,169(8):e151797.
[8]LIU J,CAO H Y,WANG H W,et al.The role of lung ultrasound in diagnosis of respiratory distress syndrome in newborn infants[J].Iranian Journal of Pediatrics,2015,25(1):147-154.
[9]PEREDA M A,CHAVEZ M A,HOOPER-MIELE C C,et al.Lung ultrasound for the diagnosis of pneumonia in children:a metaanalysis[J].Pediatrics,2015,135(4):714-722.
[10]JONES B P,TAY E T,ELIKASHVILI I,et al.Feasibility and safety of substituting lung ultrasonography for chest radiography when diagnosing pneumonia in children:a randomized controlled trial[J].Chest,2016,150(1):131-138.
[11]RATH C,SURYAWANSHI P.The Fast Growth of Neonatal Lung Ultrasound:Authors Reply[J].Indian Pediatrics,2017,54(1):12-17.
[12]DAURAT A,MILLET I,ROUSTAN J P,et al.Thoracic Trauma Severity score on admission allows to determine the risk of delayed ARDS in trauma patients with pulmonary contusion[J].Injury-international Journal of the Care of the Injured,2016,47(1):147-153.