床旁肺部超声在新生儿肺炎中的诊断价值

Value of bedside lung ultrasound in the diagnosis of neonatal pneumonia

摘要:

目的 探讨床旁肺部超声在新生儿肺炎中的诊断价值。方法 收集2017年3月就诊于成都市妇女儿童中心医院新生儿重症医学科，以呼吸道症状为主诉，并在入院24 h内完善床旁肺部超声的49例新生儿的临床资料。对49例患儿的临床资料、肺部超声资料进行回顾性分析，对床旁肺部超声诊断新生儿肺炎进行诊断价值评价。结果 49例患儿中，根据新生儿肺炎诊断的金标准，44例诊断为新生儿肺炎；根据新生儿肺炎肺部超声诊断标准，38例诊断为新生儿肺炎。肺部超声在有呼吸道症状新生儿中诊断新生儿肺炎的敏感性为 86%，特异性为100%，阳性预测值为100%，阴性预测值为45%。44例金标准诊断的新生儿肺炎患儿中，肺部超声声像图显示，44例（100%）均出现B线，表现为异常胸膜线的比例达75%，部分患儿出现斑片/局限性弱回声区（36%）或肺泡间质综合征（27%）、支气管充气征（20%）等。结论 床旁肺部超声作为新的临床诊断技术，对新生儿肺炎的诊断敏感性高、特异性强，可作为新生儿肺炎诊断的工具。

Abstract:

Objective To study the value of bedside lung ultrasound in the diagnosis of neonatal pneumonia. Methods A total of 49 neonates who were admitted to the Neonatal Intensive Care Unit of Chengdu Women and Children's Central Hospital in March 2017 with respiratory symptoms as the chief complaint were enrolled. Bedside lung ultrasound was performed within 24 hours after admission. A retrospective analysis was performed for their clinical data and lung ultrasound findings. The value of bedside lung ultrasound in the diagnosis of neonatal pneumonia was evaluated. Results According to the gold standard for the diagnosis of neonatal pneumonia, of all 49 neonates, 44 were diagnosed with pneumonia. According to the criteria for the diagnosis of neonatal pneumonia based on lung ultrasound findings, 38 neonates were diagnosed with pneumonia. In the neonates with respiratory symptoms, lung ultrasound had a sensitivity of 86%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 45% in the diagnosis of neonatal pneumonia. Among the 44 cases of neonatal pneumonia diagnosed by the gold standard, the lung ultrasonic images showed B-lines in all 44 neonates (100%), 75% had pleural line abnormalities, 36% had patchy or local hypoechoic area in the lung, 27% had alveolar-interstitial syndrome, and 20% had air bronchogram. Conclusions As a new diagnostic technique in clinical practice, bedside lung ultrasound has a high sensitivity and specificity for the diagnosis of neonatal pneumonia and can thus be used as a tool for the diagnosis of this disease.