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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2016, Vol. 13 ›› Issue (12) : 898 -903. doi: 10.3877/cma.j.issn.1672-6448.2016.12.005

所属专题： 文献；

胸部超声影像学

肺部超声诊断新生儿肺炎的临床应用
刘芳1, 岳瑾琢1,†(), 刘百灵1, 王婷1   
  1. 1. 710002　西安市儿童医院超声科
  • 收稿日期:2016-05-23 出版日期:2016-12-01
  • 通信作者: 岳瑾琢

The role of lung ultrasound in diagnosis of neonatal pneumonia

Fang Liu1, Jinzhuo Yue1,†(), Bailing Liu1, Ting Wang1   

  1. 1. Department of Ultrasound, Xi′an Children′s Hospital, Xi′an 710003, China
  • Received:2016-05-23 Published:2016-12-01
  • Corresponding author: Jinzhuo Yue
  • About author:
    Corresponding author: Yue Jinzhuo, Email:
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刘芳, 岳瑾琢, 刘百灵, 王婷. 肺部超声诊断新生儿肺炎的临床应用[J]. 中华医学超声杂志（电子版）, 2016, 13(12): 898-903.

Fang Liu, Jinzhuo Yue, Bailing Liu, Ting Wang. The role of lung ultrasound in diagnosis of neonatal pneumonia[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2016, 13(12): 898-903.

目的

探讨肺部超声对新生儿肺炎的临床诊断价值。

方法

对2015年4~10月西安市儿童医院新生儿科连续收治的100例患儿进行肺部超声扫查，分别对双侧肺脏的前上、前下、侧上、侧下、后上、后下6个区域，共12个肺区进行纵向及横向扫查，记录检查当日动脉血气分析结果。由经验丰富的同一名超声医师，在不知晓临床诊断结果前对患儿超声图像进行分析，将超声诊断结果与临床诊断结果进行对照，总结肺炎组与无肺炎组患儿超声图像特征；肺炎组患儿进行超声肺评分（LUS），将LUS与动脉血气分析的氧分压（PO2）、二氧化碳分压（PCO2）、pH值、血氧饱和度（SO2）进行相关性分析。

结果

肺炎组患儿肺部超声声像图特征：（1）超声"彗星尾"征（ULCs）："火箭"征33例（53%），"磨玻璃"征35例（56%），"瀑布"征31例（50%），弥漫性白肺8例（13%）；（2）胸膜下肺实变35例（56%）；（3）胸膜线异常26例（41%）；（4）胸腔积液7例（11%）；（5）肺不张3例（4%）；（6）气胸1例（1%）。肺部超声诊断新生儿肺炎的的特异度为86.84%，敏感度为96.77%，准确性为93.00%，阳性预测值为92.30%，阴性预测值为94.28%。LUS与PO2、PCO2、pH值、SO2相关（r=-0.82、0.64、-0.58、-0.74，P值均<0.05）。

结论

肺部超声检查的敏感度较高，可作为临床诊断新生儿肺炎的又一影像学方法，结合LUS，对指导临床治疗新生儿肺炎有一定的应用价值。

关键词: 肺, 超声检查, 肺炎, 婴儿，新生
Objective

To evaluate the role of lung ultrasound in the diagnosis of neonatal pneumonia.

Methods

From April to October 2015, 100 neonates admitted to the Neonatal Department of Xi′an Children′s Hospital underwent lung ultrasound, using the 12 regions method. All intercostal spaces of the upper and lower parts of the anterior, lateral, and posterior regions of the left and right lung were examined. Arterial blood gas analysis parameters of each case were recorded at the same time, including arterial partial pressure of oxygen (PO2), arterial partial pressure of carbon dioxide (PCO2), pH value and oxygen saturation (SO2). A skilled sonographer analyzed the ultrasound images before being aware of the patient′s clinical condition. According to the findings, the patients were classified into 2 groups: neonatal pneumonia group and non-pneumonia group. All the patients with neonatal pneumonia underwent lung ultrasound score (LUS), and the correlation between LUS and PO2, PCO2, pH value and SO2 was analyzed.

Results

A final diagnosis of neonatal pneumonia was confirmed in 62/100 patients. The ultrasonographic manifestations of neonatal pneumonia were as follows: rocket sign (33/62 patients, 53%), ground-glass sign (35/62 patients, 56%) , waterfall sign (31/62 patients, 50%), white lung (8/62 patients, 13%), subpleural lung consolidation (35/62 patients, 56%), pleural line abnormalities (26/62 patients, 41%), pleural effusion (7/62 patients, 11%), atelectasis (3/62 patients, 4%) , and pneumothorax (1/62 patients, 1%). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of lung ultrasound in the diagnosis of neonatal pneumonia was 96.77%, 86.84%, 93.00% of 92.30%, of 94.28%, respectively. The correlation coefficients between LUS and PO2, PCO2, pH value, SO2 were -0.82, 0.64, -0.58, -0.74, P<0.05, respectively.

Conclusion

Lung ultrasound is a reliable tool for diagnosing neonatal pneumonia with high sensitivity, with high practical value in assisting clinicians to carry out appropriate treatment in combination with LUS.

Key words: Lung, Ultrasonography, Pneumonia, Infant, newborn
表1 肺炎组与非肺炎组患儿一般临床资料比较（±s）
组别 例数 年龄（d） 体重（kg） 出生胎龄（周） 呼吸频率（次/分） 收缩压（mmHg） 舒张压（mmHg） 胸膜厚度（mm）
肺炎组 38 11.4±10.7 3.2±0.7 38.5±2.5 51.8±7.5 71.8±9.1 41.7±6.5 0.8±0.3
对照组 62 9.5±7.0 3.1±0.4 39.0±1.4 45.4±2.8 74.1±5.3 43.8±6.1 0.5±0.2
t值 ? 1.62 0.78 0.88 3.11 1.37 0.17 2.89
P值 ? >0.05 >0.05 >0.05 <0.001 >0.05 >0.05 <0.001
表2 肺部超声与临床诊断新生儿肺炎的结果比较（例）
肺部超声检查 临床诊断 合计
肺炎 无肺炎
肺炎 60 5 65
无肺炎 2 33 35
合计 62 38 100
图1 无肺炎患儿肺部超声声像图
图2~4 肺炎组患儿肺部超声声像图。图2示肺野内胸膜线毛糙，可见4~6条B线，即"火箭"征；图3　示胸膜下不规则片状低回声实变，内见支气管充气征（竖箭头所示），周围水肿组织超声图像呈磨玻璃样改变，混响伪像在探头与实变肺组织下方反射产生，融合B线起源于实变肺组织下方（横箭头所示）；图4　为出生1 d男患儿，临床诊断：新生儿肺炎（吸入性＋感染性），LUS示胸膜线显示不清，双肺野弥漫瀑布征，A线消失，肺滑动减弱，双侧少量胸腔积液呈窄带状无回声区位于肺组织上方
图5 超声肺评分与PO2（图a）、PCO2（图b）、pH值（图c）、SO2（图d）的相关性散点图
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