摘要: |
目的:新生儿呼吸窘迫综合征(NRDS)已成为临床高危呼吸系统疾病,流行病学调查显示其发病率约为3.3%。本研究探讨肺超声诊断早产新生儿呼吸窘迫综合征的临床应用价值。方法:选取我院收治的新生儿呼吸窘迫综合征109例为研究对象。在使用外源性肺表面活性物质(EPS)和持续气道正压通气(CPAP)或常规机械通气(CMV)治疗前进行肺超声检查,同时进行血气分析和胸透(CXR)检查。为诊断早产儿NRDS,制定了三种超声诊断标准(诊断标准A、B和C)。评价不同肺超声诊断标准的敏感性、特异性、kappa值和roc曲线。结果:前瞻性招募了109名患有NRDS的早产儿。A标准对NRDS诊断敏感性和阴性预 测值均为100%。B诊断标准敏感性和阴性预测值均高于C诊断标准(P<0.05),敏感性明显高于C诊断标准(P<0.05)。31例NRDS中,15例有严重疾病,16例无严重NRDS。根据C诊断标准,严重NRDS的诊断敏感性、特异性、阳性预测值和阴性预测值分别为73.33%(44.83%~91.09%)、93.75%(67.71%~99.67%)、91.66%(59.75%~99.56%)、78.94%(53.90%~93.02%),kappa值和AUC分别为0.676、0.8%。分别为35。结论 胸膜线增厚或粗大伴白肺征是肺超声诊断NRDS的重要影像学特征。白肺征结合肺实变征对非严重NRD患者的严重NRD有较高的诊断价值。 |
关键词: 早产儿 NRDS 肺超声检查 敏感性 特异性 诊断 |
DOI: |
投稿时间:2020-05-10修订日期:2020-06-15 |
基金项目: |
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Clinical efficacy of pulmonary ultrasonography in diagnosis of neonatal respiratory distress syndrome in preterm infants |
Zheng Lei |
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Abstract: |
Objective: Neonatal respiratory distress syndrome (NRDS) has become a clinically high-risk respiratory disease, with epidemiological investigations indicating an incidence of approximately 3.3%. Methods: Pulmonary ultrasonography was performed prior to treatment with Exogenous Pulmonary Surfactant (EPS) and Continuous Positive Airway Pressure (CPAP) or Conventional Mechanical Ventilation (CMV).Simultaneous blood gas analysis and chest X-ray (CXR) examination as was also performed. Three types of ultrasound diagnostic criteria were developed to diagnose preterm infants with NRDS(diagnostic criteria A, B and C). The sensitivity, specificity, Kappa value and ROC curve of different pulmonary ultrasonography diagnostic criteria were evaluated. Results: One hundred and nine preterm infants with NRDS were prospectively recruited. The sensitivity and negative predictive value of NRDS in preterm infants with A diagnostic criteria were 100%. The B diagnostic criteria sensitivity and negative predictive values were higher than the C diagnostic criteria(p<0.05), especially the sensitivity was significantly higher than the C diagnostic criteria(p<0.05). Of the 31 NRDS, 15 cases had the severe disease and other 16 had none severe NRDS. According to the C diagnostic standard, the diagnostic sensitivity, specificity, positive predictive value and negative predictive value of sever NRDS were 73.33% (44.83%~91.09%), 93.75% (67.71%~99.67%),91.66%(59.75%~99.56%), 78.94%(53.90%~93.02%) with the Kappa value and AUC of 0.676, 0.835 respectively. Conclusion Pleural line thickening or rough with white lung sign is an important image features for diagnosis of NRDS by pulmonary ultrasonography. White lung sign combined with the lung consolidation sign had high diagnostic efficacy in detection severe NRDS from none sever NRDS. |
Key words: preterm infants NRDS pulmonary ultrasonography sensitivity specificity diagnosis |