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肺超声评分和Downes评分预测新生儿呼吸支持方式选择的研究

The predictive values of lung ultrasound score and Downes score for respiratory support strategies in newborns
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摘要 目的探讨肺超声(lung ultrasound,LUS)评分和Downes评分对新生儿呼吸支持方式选择的预测价值。方法选择2021年9月至2022年7月淮安市妇幼保健院新生儿医学中心收治且伴呼吸困难的新生儿进行前瞻性研究,根据入院时呼吸支持方式分为无创组、有创组和对照组,观察患儿生后6 h、24 h和48 h LUS评分和Downes评分变化,绘制LUS评分和Downes评分预测呼吸困难新生儿采取呼吸支持方式的受试者工作特征曲线。结果共纳入263例,无创组105例,有创组56例,对照组102例。3组患儿生后同一时间点LUS评分和Downes评分的组间比较差异均有统计学意义(P<0.05);各组组内不同时间点LUS评分和Downes评分的比较差异均有统计学意义(P<0.05)。3组患儿的LUS评分和Downes评分均随治疗时间延长有所下降,且同一时间点有创组均高于无创组和对照组(P<0.05),无创组均高于对照组(P<0.05)。LUS评分、Downes评分和动脉血氧分压/吸入氧气分数两两之间均呈正相关(P<0.05)。生后6 h内LUS评分、Downes评分预测呼吸困难新生儿需要无创呼吸支持治疗的曲线下面积分别为0.900(95%CI0.861~0.940,P<0.05)、0.889(95%CI0.847~0.931,P<0.05),界值均为2.5分;LUS评分联合Downes评分预测的曲线下面积为0.944(95%CI0.915~0.973,P<0.05)。生后6 h内LUS评分、Downes评分预测呼吸困难新生儿需要有创呼吸支持治疗的曲线下面积分别为0.979(95%CI0.963~0.995,P<0.05)、0.831(95%CI0.760~0.902,P<0.05),界值均为5.5分;LUS评分联合Downes评分预测的曲线下面积为0.985(95%CI0.972~0.998,P<0.05)。结论LUS评分和Downes评分均对新生儿呼吸支持方式的选择有一定的预测价值。 Objective To study the predictive values of lung ultrasound(LUS)score and Downes score in selecting respiratory support strategies for newborns with dyspnea.Methods From September 2021 to July 2022,newborns admitted to our hospital with dyspnea were selected and assigned into the non-invasive respiratory support(N)group,invasive respiratory support(I)group and control(C)group based on the respiratory support strategies on admission.LUS scores and Downes scores at 6,24,and 48 h after birth were recorded.ROC curves were drawn to determine the predictive values of LUS and Downes scores for respiratory support strategies.Results A total of 263 cases were enrolled,including 105 cases in N group,56 cases in I group and 102 cases in C group.The differences of LUS and Downes scores between the three groups at the same timepoint were statistically significant with I group had the highest scores,N group second and C group lowest(P<0.05).LUS and Downes scores within each group at different timepoints were significantly different(P<0.05).In all three groups,LUS and Downes scores were decreased with longer duration of treatment.LUS score,Downes score and PaO2/FiO2 were positively correlated with each other(P<0.05).The area under the curve(AUC)of LUS score and Downes score predicting non-invasive respiratory support within 6 h after birth were 0.900(95%CI 0.861-0.940,P<0.05)and 0.889(95%CI 0.847-0.931,P<0.05),respectively,with the same cutoff of 2.5.The AUC of the combination of LUS and Downes scores predicting non-invasive respiratory support was 0.944(95%CI 0.915-0.973,P<0.05).The AUC of LUS score and Downes score predicting invasive respiratory support were 0.979(95%CI 0.963-0.995,P<0.05)and 0.831(95%CI 0.760-0.902,P<0.05),respectively,with the same cutoff of 5.5.The AUC of the combination of LUS and Downes scores predicting invasive respiratory support was 0.985(95%CI 0.972-0.998,P<0.05).Conclusions Both LUS score and Downes score have certain predictive values for respiratory support strategies in newborns with dyspnea.
作者 李磊 张婷婷 马瑜 胡金绘 潘兆军 武荣 Li Lei;Zhang Tingting;Ma Yu;Hu Jinhui;Pan Zhaojun;Wu Rong(Newborn Medical Center of Huai'an Maternal and Child Health Hospital Affiliated to Yangzhou University School of Medicine,Huai'an 223002,China)
出处 《中华新生儿科杂志(中英文)》 CAS CSCD 2024年第2期90-94,共5页 Chinese Journal of Neonatology
基金 江苏省卫生健康委科研课题(H2018009) 江苏省妇幼健康科研项目(F201812)。
关键词 肺超声评分 Downes评分 呼吸困难 新生儿 机械通气 Lung ultrasound score Downes score Dyspnea Neonate Mechanical ventilation
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