肺脏超声在新生儿感染性肺炎诊断中的临床价值

doi:10.6040/j.issn.1671-7554.0.2017.1239

摘要/Abstract

摘要： 目的探讨肺脏超声(LUS)在新生儿感染性肺炎(IPN)中的临床应用价值。方法回顾性分析2016年5月至2017年10月住院的80例IPN患儿的LUS及胸部X线(CXR)检查结果,比较两者的检出率,并对所有LUS诊断为IPN的患儿进行LUS随访,观察疗效。结果 80例IPN患儿中LUS诊断76例,CXR诊断65例,其中4例CXR表现为阳性而LUS表现为阴性,15例CXR表现为阴性而LUS表现为阳性。76例患儿均行LUS随访观察,至10~14 d时40例患儿的声像图表现为正常,15例患儿表现为实变区消失,但仍可见散在或较致密的B-线;13例患儿的实变区域较入院时明显减小,表现为胸膜下的小片状实变,8例患儿的实变区较入院时变化不明显且其中4例伴有肺搏动。结论肺脏超声对IPN的诊断具有很高的临床价值,能动态观察病情的变化,可作为IPN的首选影像学检查诊断方法。

关键词: 肺脏超声, 新生儿, 肺炎, 胸部X线

Abstract: Objective To discuss the clinical value of lung ultrasound(LUS)in the diagnosis of neonatal infectious pneumonia(IPN). Methods The chest X-ray(CXR)and LUS results of 80 infants with IPN clinical signs and symptoms from May 2016 to Oct. 2017 were retrospectively analyzed, and the positive diagnosis rates were also comparied. The IPN infants diagnosed by LUS were followed up to observe therapeutic effects. Results The positive diagnosis rate of LUS and CXR were respective 95%(76/80)and 81%(65/80), in which 4 infants were CXR positive while LUS negative, 15 infants were CXR negative while LUS positive. Seventy-six infants were followed up with LUS, in which 40 showed a complete regression, 15 had absorptions of consolidation while with scattered or confluent B-lines, 13 had significantly reduced consolidation, 8 had no obvious changes in size of consolidation, and 4 exhibited a “lung pulse”. Conclusion LUS is of great value in diagnosis and monitor the progresses of IPN, and can be used as the preferred diagnostic method in imaging.

Key words: Lung ultrasound, Neonatal, Pneumonia, Chest X-ray

中图分类号:

R445

袁鹏,李娅,张飞雪,王青. 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, WANG Qing. Clinical value of lung ultrasound in the diagnosis of neonatal infectious pneumonia[J]. Journal of Shandong University (Health Sciences), 2018, 56(6): 29-34.

参考文献

[1] 郭艳梅,刘翠青.河北省儿童医院新生儿呼吸衰竭的临床流行病学特点[J].中华围产医学杂志,2012, 15(11): 670-675. GUO Yanmei, LIU Cuiqing. Clinical epidemiological characteristics of neonatal respiratory failure in Childrens Hospital of Hebei Province[J]. Chin J Perinat Med, 2012, 15(11): 670-675.
[2] Lichtenstein DA, Lascols N, Mezière G, et al. Ultrasound diagnosis of alveolar consolidation in the critically ill[J]. Intensive Care Med, 2004, 30(2): 276-281.
[3] Alrajhi K, Woo MY, Vaillancourt C. Test characteristics of ultrasonography for the detection of pneumothorax: a systematic review and meta-analysis[J]. Chest, 2012, 141(3): 703-708.
[4] Caiulo VA, Gargani L, Caiulo S, et al. Lung ultrasound characteristics of community-acquired pneumonia in hospitalized children[J]. Pediatr Pulmonol, 2013, 48(3): 280-287.
[5] Chen L, Zhang Z. Beside ultrasonography for diagnosis of pneumothorax[J]. Quant Imageing Med Surg, 2015, 5(4): 618-623.
[6] Reissig A, Gramegna A, Aliberti S. The role of lung ultrasound in the diagnosis and follow-up of community-acquired pneumonia[J]. Eur J Intern Med, 2012, 23(5): 391-397.
[7] Volpicelli G, Elbarbary M, Blaivas M, et al. International evidence based recommendations for point-of-care lung ultrasound[J]. Intensive Care Med, 2012, 38(4): 577-591.
[8] 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: 401-405.
[9] Strauss K, Kaste S. The ALARA(as low as reasonably achievable)concept in pediatric interventional and fluoroscopic imaging: striving to keep radiation doses as low as possible during fluoroscopy of pediatric patients-a white paper executive summary[J]. Pediatr Radiol, 2006, 36(2): 110-112.
[10] Frush DP. Radiation, thoracic imaging, and children: radiation safety[J]. Radiolclin North Am, 2011, 49(5): 1053-1069.
[11] Thomas KE, Parnell-Parmley JE, Haidar S, et al. Assessment of radiation dose awareness among pediatricians[J]. Pediatr Radiol, 2006, 36(8): 823-832.
[12] Reali F, Sferrazza Papa GF, Carlucci P, et al. Can lung ultrasound replace chest radiography for the diagnosis of pneumonia in hospitalized children?[J]. Respiration, 2014, 88(2): 112-115.
[13] Copetti R, Cattarossi L. Ultrasound diagnosis of pneumonia in children[J]. Radiol Med, 2008, 113(2): 190-198.
[14] Pagano A, Numis FG, Visone G, et al. Lung ultrasound for diagnosis of pneumonia in emergency department[J]. Intern Emerg Med, 2015, 10(7): 851-854.
[15] Reissig A, Copetti R, Mathis G, et al. Lung ultrasound in the diagnosis and follow-up of community acquired pneumonia: a prospective multicentre diagnostic accuracy study[J]. Chest, 2012, 142(4): 965-972.
[16] 刘敬,王华伟,韩涛,等.肺脏超声诊断新生儿感染性肺炎[J].中华围产医学杂志,2014, 17(7): 468-472. LIU Jing, WANG Huawei, HAN Tao, et al. Lung ultrasonography for the diagnosis of severe neonatal pneumonia[J]. Chinese Journal of Perinatal Medicine, 2014, 17(7): 468-472.
[17] Basile V, Di Mauro, Scalini E, et al. Lung ultrasound: a useful tool in diagnosis and management of bronchiolitis[J]. BMC Pediatr, 2015, 15(1): 63.
[18] Tsai NW, Ngai CW, Mok KL, et al. Lung ultrasound imaging in avian influenza A(H7N9)respiratory failure[J]. Crit Ultrasound J, 2014, 6(1): 1-8.
[19] 刘敬,刘颖,王华伟,等.肺脏超声对新生儿肺不张的诊断价值[J].中华儿科杂志, 2013, 51(9): 644-649. LIU Jing, LIU Ying, WANG Huawei, et al. Lung ultrasound for diagnosis of neonatal atelectasis[J]. Chin J Pediatr, 2013, 51(9): 644-649.
[20] Lichtenstein DA, Lascols N, Prin S, et al. The “lung pulse”: an early ultrasound sign of complete atelectasis[J]. Intensive Care Med, 2003, 29(12): 2187-2192.
[21] Luri D, De Candia A, Bazzocchi M. Evaluation of the lung in children with suspected pneumonia: usefulness of ultrasonography[J]. Radiol Med, 2009, 114(2): 321-330.
[22] Nazerian P, Volpicelli G, Vanni S, et al. Accuracy of lung ultrasound for the diagnosis of consolidations when compared to chest computed tomography[J]. Am J Emerg Med, 2015, 33(5): 620-625.
[23] Shah VP, Tunik MG, Tsung JW. Prospective evaluation of clinicianperformed point-of-care ultrasound for the diagnosis of pneumonia in children[J]. JAMA Pediatr, 2013, 167(2): 119-125.

相关文章 15

[1]	王翠翠,郑凤家,张雅慧,王小康,于瑞花,郝薇. 基于药代动力学/药效学模型优化新生儿美罗培南给药方案[J]. 山东大学学报 (医学版), 2026, 64(4): 83-91.
[2]	葛雪,赵红艳. 疱疹病毒感染对重症肺炎患者临床预后及呼吸道微生态的影响[J]. 山东大学学报 (医学版), 2025, 63(6): 27-37.
[3]	张如岗,殷悦,李岱云,段梦琦,刘桂莲,王瑛. 支原体感染对成人肺功能及呼出气一氧化氮的影响[J]. 山东大学学报 (医学版), 2025, 63(3): 71-75.
[4]	徐年兴,魏东,乔俊杰,战炳炎. CD8⁺、IL-6和PaO₂对不可切除Ⅲ_B/C和Ⅳ期非小细胞肺癌免疫治疗触发放射召回性肺炎的预测价值[J]. 山东大学学报 (医学版), 2025, 63(2): 29-35.
[5]	张学宇,张学海,孙文青,刘晗,姜金波,刘寒,李远,陈晓梅. 重症新型冠状病毒肺炎伴侵袭性肺曲霉病及反复致命性消化道出血1例[J]. 山东大学学报 (医学版), 2024, 62(7): 56-61.
[6]	钱凤同,李洪凯,于金龙,薛付忠. 抗菌药物使用密度与肺炎克雷伯菌耐药率的因果关联及药物控制阈值[J]. 山东大学学报 (医学版), 2024, 62(5): 103-111.
[7]	吴雪燕,高英静,刘思言,王少莲. 以手足及面部麻木为首发表现的青少年孤立肾漏诊1例并文献复习[J]. 山东大学学报 (医学版), 2024, 62(3): 121-124.
[8]	王玉淼,崔晓霈,张红雨. 高龄老年新型冠状病毒肺炎患者应用抗凝治疗的短期疗效和安全性[J]. 山东大学学报 (医学版), 2024, 62(12): 21-31.
[9]	陈文军,宋丽君,王俊娟. 食管裂孔疝患者行无痛胃镜检查并发肺炎5例并文献复习[J]. 山东大学学报 (医学版), 2024, 62(1): 71-75.
[10]	杨庆婵,王咏梅,王承志. 急性纤维素性机化性肺炎3例病理特征及文献复习[J]. 山东大学学报 (医学版), 2023, 61(6): 58-64.
[11]	李骁,孙志远,张龙江. 影像人工智能在肺炎筛查、诊断及预测领域的应用研究进展[J]. 山东大学学报 (医学版), 2023, 61(12): 13-20.
[12]	王园园,孙云. 合并新型冠状病毒肺炎的维持性血液透析患者死亡危险因素[J]. 山东大学学报 (医学版), 2023, 61(11): 68-73.
[13]	宋绍秀,徐勇胜. 儿童肺炎支原体肺炎合并肺栓塞9例临床分析并文献复习[J]. 山东大学学报 (医学版), 2023, 61(11): 96-103.
[14]	吴远宁,季翔,潘云,张锦涛,亓倩,董亮. X连锁淋巴组织增生性疾病成人患者1例[J]. 山东大学学报 (医学版), 2023, 61(10): 117-120.
[15]	李玉风,刘超越,朱晓波,薛江,王一彪. 妊娠同族免疫性肝病-新生儿血色病1例[J]. 山东大学学报 (医学版), 2023, 61(1): 118-120.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed