摘要
目的:探析肺超声评分(LUS)在新生儿呼吸窘迫综合征(NRDS)病情诊断及机械通气撤离中的应用价值。方法:回顾性分析86例确诊为NRDS行机械通气治疗患儿的资料,根据新生儿呼吸窘迫评分分为轻度组39例、中度组34例和重度组13例,并根据首次机械通气撤离情况分为成功组66例和失败组20例;比较轻、中、重度组机械通气撤离前LUS、X线分级和动脉血气指标,分析LUS对NRDS病情的预测效能,以及机械通气撤离失败的危险因素。结果:轻、中、重度组LUS、X线分级、二氧化碳分压(PaCO_(2))、氧分压(PaO2)及动脉血氧指数(PaO_(2)/FiO_(2))比较,差异均有统计学意义(均P<0.05)。X线分级、PaCO_(2)与LUS均呈正相关(r=0.686,0.690;均P<0.05),PaO_(2)、PaO_(2)/FiO_(2)与LUS均呈负相关(r=-0.660,-0.833;均P<0.05)。LUS评分预测轻、中度NRDS的AUC为0.975,最佳截断值为16.89分,敏感度、特异度分别为94.12%、94.87%;LUS预测中、重度NRDS的AUC为0.947,最佳截断值为27.09分,敏感度、特异度分别为92.31%、91.18%。失败组LUS、X线分级Ⅳ级比例、PaCO_(2)、胎龄≤30周比例和总机械通气时间显著高于成功组,X线分级Ⅰ~Ⅱ级比例、PaO_(2)、PaO_(2)/FiO_(2)、体质量和1 min Apgar评分均显著低于成功组(均P<0.05)。logistic回归分析显示,LUS、X线分级、PaO_(2)/FiO_(2)、胎龄、1 min Apgar评分及总机械通气时间是NRDS患儿机械通气撤离失败的危险因素,体质量是其保护因子(P<0.05)。结论:LUS可准确预测NRDS的病情严重程度,为患儿机械通气成功撤离提供指导。
Objective:To investigate the application value of the lung ultrasound score(LUS)in in disease severity assessment and weaning from mechanical ventilation(MV)in neonate with neonatal respiratory distress syndrome(NRDS).Methods:The clinical data of 86 neonates who were diagnosed with NRDS and treated with MV were retrospectively analyzed.The neonates were divided into a mild group(39 cases),a moderate group(34 cases)and a severe group(13 cases)and then divided into a success group(66 cases)and a failure group(20 cases)according to the first weaning from MV.The LUS,X-ray grading and the indicators from Arterial Blood Gas(ABG)before weaning were compared of each groups.The predictive performance of LUS to disease severity and the risk factors for weaning failure were analyzed.Results:The LUS,X-ray grade,PaCO_(2),PaO_(2) and PaO_(2)/FiO_(2) had statistical differences in the mild,moderate and severe groups(all P<0.05).X-ray grade and PaCO_(2) were positively correlated with LUS(r=0.686,0.690,P<0.05),while PaO_(2) and PaO2/FiO2 were negatively correlated with LUS(r=-0.660,-0.833,P<0.05).The AUC,best cutoff value,sensitivity and specificity of LUS in differential diagnosis for mild and moderate NRDS were 0.975,16.89 points,94.12%and 94.87%,and those for moderate and severe NRDS were 0.947,27.09 points,92.31%and 91.18%,respectively.LUS,proportion of X-ray gradeⅣ,PaCO_(2),proportion of gestational age≤30 weeks and total MV time in the failure group were significantly higher than those in the success group,while the proportion of X-ray gradeⅠ~Ⅱ,PaO_(2),PaO_(2)/FiO_(2),birth weight and 1 min Apgar score were significantly lower than those in the success group(all P<0.05).Logistic regression analysis showed that LUS,X-ray grade,PaO_(2)/FiO_(2),gestational age,1 min Apgar score and total MV time were risk factors for weaning failure in neonates with NRDS,and birth weight was a protective factor(P<0.05).Conclusions:LUS can be used to predict the severity of NRDS and provide guidance for successful weaning from MV.
作者
杨汶铭
郑旭
高龙臣
贾立杨
赵红敏
YANG Wenming;ZHENG Xu;GAO Longchen;JIA Liyang;ZHAO Hongmin(Department of Ultrasound,Yihe Branch of Cangzhou People’s Hospital,Cangzhou 061000,China)
出处
《中国中西医结合影像学杂志》
2023年第6期682-686,706,共6页
Chinese Imaging Journal of Integrated Traditional and Western Medicine
基金
河北省卫生健康青年科技课题(20220322)。
关键词
呼吸窘迫综合征
新生儿
肺超声评分
病情诊断
机械通气
应用价值
Respiratory distress syndrome
Neonate
Lung ultrasound score
Diagnosis
Mechanical ventilation
Application value
