山东大学学报 (医学版) ›› 2021, Vol. 59 ›› Issue (7): 50-56.doi: 10.6040/j.issn.1671-7554.0.2020.1715
• • 上一篇
刘晓1,郭新元2,张德健2,李琦2,李宁1,薛江2
LIU Xiao1, GUO Xinyuan2, ZHANG Dejian2, LI Qi2, LI Ning1, XUE Jiang2
摘要: 目的 研究床旁肺脏超声(LUS)及其评分在诊断新生儿呼吸窘迫综合征(NRDS)及评估肺泡表面活性物质(PS)疗效中的作用。 方法 选择确诊的NRDS患儿70例为观察组,非肺病患儿70例为对照组。将患儿肺脏的体表投影分为12个区域。记录每个区域的超声下NRDS征象和LUS评分。观察组于PS治疗前行床旁LUS检查,对照组纳入研究后即行床旁LUS检查。两组对比,以评估LUS在诊断NRDS中的价值。观察组中60例符合应用PS指征,于PS应用后12 h再次行床旁LUS检查。对比PS应用前后血气分析及胸片等结果、LUS下NRDS征象的检出率及LUS评分,观察LUS在评估PS疗效中的作用。 结果 观察组NRDS征象检出率以及LUS评分均高于对照组(P<0.001)。LUS评分对NRDS诊断有较高的灵敏度(98.57%)、特异度(100%),对预测NRDS患儿使用PS亦具有较高灵敏度(90.00%)、特异度(90.00%)。观察组PS应用后12 h,较PS应用前的NRDS征象明显减少, LUS评分明显降低(P<0.001)。 结论 床旁LUS诊断NRDS准确可靠,动态观察并结合LUS评分可准确评估PS对NRDS的治疗效果。
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[1] 邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M].4版.北京:人民卫生出版社,2011:395-398. [2] Stoll B, Hansen N, Bell E, et al. Neonatal outcomes of extremely preterm infants from the NICHD neonatal research network [J]. Pediatrics, 2010, 126(3): 443-456. [3] Consortium on Safe Labor, Hibbard JU, Wilkins I, et al. Respiratory morbidity in late preterm births [J]. JAMA, 2010, 304(4): 419-425. [4] Mally P, Hendricks-Muñoz K, Bailey S. Incidence and etiology of late preterm admissions to the neonatal intensive care unit and its associated respiratory morbidities when compared to term infants[J]. Am J Perinatol, 2013, 30(5): 425-431. [5] Sweet D, Carnielli V, Greisen G, et al. European consensus guidelines on the management of respiratory distress syndrome-2016 update [J]. Neonatology, 2017, 111(2): 107-125. [6] Shim GH. Update of minimally invasive surfactant therapy [J]. Korean J Pediatr, 2017, 60(9): 273-281. [7] Harbron RW. Cancer risks from low dose exposure to ionising radiation-is the linear no-threshold model still relevant? [J]. Radiography, 2012, 18(1): 28-33. [8] 刘敬, 李洁, 单瑞艳,等.新生儿呼吸窘迫综合征超声诊断与分度多中心前瞻性研究[J]. 中国小儿急救医学, 2020, 27(11): 801-807. LIU Jing, LI Jie, SHAN Ruiyan, et al. Ultrasound diagnosis and grading of neonatal respiratory distress syndrome: a multicenter prospective study [J]. Chinese Pediatric Emergency Medicine, 2020, 27(11): 801-807. [9] 刘敬, 曹海英, 程秀永. 新生儿肺脏疾病超声诊断学[M]. 郑州:河南科学技术出版社,2019:69-86. [10] Hiles M, Culpan AM, Watts C, et al. Neonatal respiratory distress syndrome: chest X-ray or lung ultrasound?—a systematic review[J]. Ultrasound, 2017, 25(2): 80-91. [11] 焦逢春,岳凯涛,李娟.新生儿气胸临床特点分析与救治策略[J]. 临床外科杂志, 2020, 28(11): 23-24. [12] Sharma D, Farahbakhsh N. Role of chest ultrasound in neonatal lung disease: a review of current evidences [J]. J Matern Fetal Neonatal Med, 2019, 32(2): 310-316. [13] 李广洪,罗惠玲,白波.肺部超声诊断新生儿暂时性呼吸困难的价值[J].临床超声医学杂志, 2020, 22(10): 755-758. LI Guanghong, LUO Huiling, BAI Bo. Value of lung ultrasound in the diagnosis of transient tachypnea in newborns [J]. Journal of Clinical Ultrasound in Medicine, 2020, 22(10): 755-758. [14] 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. YUAN Peng, LI Ya, ZHANG Feixue, et al. Clinical value of lung ultrasound in the diagnosis of neonatal infectious pneumonia[J]. Journal of Shandong University(Health Sciences), 2018, 56(6): 29-34. [15] 封在李, 尹兆青, 段正凡,等.肺脏超声在新生儿肺不张疾病检查中的应用价值[J].中国临床新医学,2021,14(1): 56-59. FENG Zaili, YIN Zhaoqing, DUAN Zhengfan, et al. The application value of lung ultrasound in the examination of neonatal atelectasis [J]. Chinese Journal of New Clinical Medicine, 2021, 14(1): 56-59. [16] Bouhemad B, Liu ZH, Arbelot C, et al. Ultrasound assessment of antibiotic-induced pulmonary reaeration in ventilator-associated pneumonia[J]. Crit Care Med, 2010, 38(1): 84-92. [17] Ahn KH, Lee EH, Cho GJ, et al. Anterior placenta previa in the mid-trimester of pregnancy as a risk factor for neonatal respiratory distress syndrome[J]. PLoS One, 2018, 13(11): e0207061. doi: 10.1371/journal.pone.0207061. [18] Spillane NT, Zamudio S, Alvarez-Perez J, et al. Increased incidence of respiratory distress syndrome in neonates of mothers with abnormally invasive placentation[J]. PLoS One, 2018, 13(7): e0201266. doi: 10.1371/journal.pone.0201266. [19] Schmitz T, Alberti C, Ursino M, et al. Full versus half dose of antenatal betamethasone to prevent severe neonatal respiratory distress syndrome associated with preterm birth: study protocol for a randomised, multicenter, double blind, placebo-controlled, non-inferiority trial(BETADOSE)[J]. BMC Pregnancy Childbirth, 2019, 19(1): 67. doi: 10.1186/s12884-019-2206-x. [20] Garman EF, Weik M. X-ray radiation damage to biological samples: recent progress[J]. J Synchrotron Radiat, 2019, 26(Pt 4): 907-911. [21] Gomolka M, Oestreicher U, Röβler U, et al. Age-dependent differences in DNA damage after in vitro CT exposure[J]. Int J Radiat Biol, 2018, 94(3): 272-281. [22] Bataille B, Rao G, Cocquet P, et al. Accuracy of ultrasound B-lines score and E/Ea ratio to estimate extravascular lung water and its variations in patients with acute respiratory distress syndrome[J]. J Clin Monit Comput, 2015, 29(1): 169-176. [23] Pang H, Zhang B, Shi J, et al. Diagnostic value of lung ultrasound in evaluating the severity of neonatal respiratory distress syndrome[J]. Eur J Radiol, 2019, 116: 186-191. doi: 10.1016/j.ejrad.2019.05.004. [24] 李娅, 袁鹏, 张飞雪,等. 肺脏超声在肺表面活性物质治疗早产儿呼吸窘迫综合征中的评价作用[J]. 山东大学学报(医学版), 2018, 56(2): 34-40. LI Ya, YUAN Peng, ZHANG Feixue, et al. Lung ultrasound for evaluating the effect of pulmonary surfactant replacement therapy in preterm infants with respiratory distress syndrome[J]. Journal of Shandong University(Health Sciences), 2018, 56(2): 34-40. [25] De Martino L, Yousef N, Ben-Ammar R, et al. Lung Ultrasound score predicts surfactant need in extremely preterm neonates[J]. Pediatrics, 2018, 142(3): e20180463. doi: 10.1542/peds.2018-0463. [26] Perri A, Riccardi R, Iannotta R, et al. Lung ultrasonography score versus chest X-ray score to predict surfactant administration in newborns with respiratory distress syndrome[J]. Pediatr Pulmonol, 2018, 53(9): 1231-1236. [27] 郝小清, 刘弦, 胡金绘,等. 肺超声评分预测呼吸窘迫极低出生体重儿对肺表面活性物质需求的研究[J]. 中华新生儿科杂志, 2020, 35(3): 220-222. [28] 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 Pediatr, 2015, 169(8): e151797. doi: 10.1001/jamapediatrics.2015.1797. [29] Oktem A, Yigit S, Oguz B, et al. Accuracy of lung ultrasonography in the diagnosis of respiratory distress syndrome in newborns[J]. J Matern Fetal Neonatal Med, 2021, 34(2): 281-286. [30] 刘敬. 对肺脏超声评分系统的几点思考[J]. 中国小儿急救医学, 2019, 26(8): 561-564. |
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