摘要
目的:探讨肺部超声(LUS)评分判断羊水胎粪污染新生儿肺部病变的严重程度,并指导临床应用不同呼吸支持方式的价值。方法:选取2017年1月-2018年5月在东莞市儿童医院新生儿科住院治疗的羊水胎粪污染患儿83例。根据患儿生后72 h内呼吸困难程度及呼吸支持方式分为三组:有创机械通气呼吸支持组(重症组,30例)、无创通气呼吸支持组(轻症组,21例)及无呼吸困难组(对照组,32例),比较三组患儿一般情况、入院6 h内第一次肺部超声LUS评分;重症组根据撤机是否成功分为撤机成功组和撤机失败组,比较两组入院6小时内第一次肺部超声LUS评分、撤机前LUS评分;并应用ROC曲线评价LUS评分预测患儿需要有创机械通气呼吸支持的效能。结果:(1)重症组、轻症组及对照组平均出生体重、平均出生胎龄、性别比例比较差异均无统计学意义(P>0.05)。(2)对照组肺部超声表现接近于正常,或以轻度肺水肿为主要表现,重症组及轻症组表现为不同程度的实变、水肿、肺不张;重症组入院6 h内第一次肺部超声LUS评分明显高于轻症组及对照组,差异有统计学意义(P<0.05);重症组有8例患儿撤机失败,撤机成功组与撤机失败组入院6 h内第一次肺部超声LUS之间差异无统计学意义(P>0.05),但撤机失败组撤机前LUS评分高于撤机成功组,差异有统计学意义(P<0.05);(3)经ROC曲线分析,结果显示:曲线下面积(AUC)=0.956,95%CI(0.906,1.000),可认为LUS评分预测患儿需要有创机械通气呼吸支持治疗的准确性较高,其中灵敏度0.933,特异度0.820,诊断界值18.50,即LUS评分超过18.50分,预测需要有创机械通气呼吸支持治疗的机会明显增高。结论:LUS评分可较准确判断羊水胎粪污染新生儿肺部病变的严重程度,根据LUS评分能指导临床应用不同呼吸支持方式,尤其对识别需要有创机械通气呼吸支持治疗的患者具有较好的临床应用价值。
Objective:To evaluate the accuracy of lung ultrasound(LUS)for estimating the severity of meconium-stained newborns and the value in guiding respiratory support therapy for them.Method:This study included data on 83 meconium-stained newborns discharged from Neonatology Department of Dongguan Children's Hospital for the period January 2017 to May 2018.They were divided into severe group,mild group and control group according to the severity of dyspnea and the mode of respiratory support within 72 hours after birth.The general condition and the first LUS within 6 hours after admission of the three groups were compared.The severe group was divided into two groups according to whether successfully weaning.The LUS differences before extubation were compared between the two group. The ROC curve was used to evaluate the predictive efficiency for invasive mechanical ventilation.Result:The birth weight,gestational age and gender had no statistical difference between the three groups(P>0.05).The lung ultrasound manifest as normal or mild pulmonary edema in control group,and consolidation,edema and different degrees of atelectasis in severe and mild group.The first LUS in severe group was significantly higher than that in the mild group and control group.Eight cases were failed to extubation in severe group.LUS in the failure group was significantly higher than that in the success group.The area under the ROC curve of LUS score was 0.956,95%CI(0.906,1.000),it could be regarded that the accuracy of LUS for predicting invasive mechanical ventilation was stable,it’s sensitivity was 0.933 and specificity was 0.820.The diagnositic cutoff value was 18.50,if the LUS score exceeding 18.50,the need to use invasive mechanical ventilation was significantly increased.Conclusion:Lung ultrasound can accurately to estimate the severity of meconium-stained newborns.It has clinical application value for chosing different respiratory support methods.The infants with high risk of needing invasive mechanical ventilation can be early identified by LUS score.
出处
《中国医学创新》
CAS
2019年第13期59-63,共5页
Medical Innovation of China
基金
东莞市社会科技发展(一般)项目立项(201750715028112)
关键词
胎粪吸入综合征
肺部超声
呼吸支持治疗
Meconium aspiration syndrome
Lung ultrasound
Invasive mechanical ventilation
