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中华医学超声杂志(电子版) ›› 2019, Vol. 16 ›› Issue (02) : 102 -107. doi: 10.3877/cma.j.issn.1672-6448.2019.02.005

所属专题: 文献

重症超声影像学

心肺联合超声在低氧血症新生儿中的应用价值
赵敏1, 包凌云2,(), 吴漪皓3, 黄先玫4, 李晓霞4, 芦惠4, 蒋春明4   
  1. 1. 310006 浙江大学医学院附属杭州市第一人民医院超声影像科;310022 杭州市老年病医院超声科
    2. 310006 浙江大学医学院附属杭州市第一人民医院超声影像科
    3. 310006 浙江大学医学院附属杭州市第一人民医院心内科
    4. 310006 浙江大学医学院附属杭州市第一人民医院儿科
  • 收稿日期:2018-08-30 出版日期:2019-02-01
  • 通信作者: 包凌云

Diagnostic value of integrated cardiopulmonary ultrasound in neonates with hypoxemia

Min Zhao1, Lingyun Bao2,(), Yihao Wu3, Xianmei Huang4, Xiaoxia Li4, Hui Lu4, Chunming Jiang4   

  1. 1. Department of Ultrasound, Hangzhou First People's Hospital, Zhejiang University Medical College, Hangzhou 310006, China; Department of Ultrasound, Hangzhou Geriatric Hospital, Hangzhou 310022, China
    2. Department of Ultrasound, Hangzhou First People's Hospital, Zhejiang University Medical College, Hangzhou 310006, China
    3. Department of Cardiology, Hangzhou First People's Hospital, Zhejiang University Medical College, Hangzhou 310006, China
    4. Department of Neonatology, Hangzhou First People's Hospital, Zhejiang University Medical College, Hangzhou 310006, China
  • Received:2018-08-30 Published:2019-02-01
  • Corresponding author: Lingyun Bao
  • About author:
    Corresponding author: Bao Lingyun, Email:
引用本文:

赵敏, 包凌云, 吴漪皓, 黄先玫, 李晓霞, 芦惠, 蒋春明. 心肺联合超声在低氧血症新生儿中的应用价值[J/OL]. 中华医学超声杂志(电子版), 2019, 16(02): 102-107.

Min Zhao, Lingyun Bao, Yihao Wu, Xianmei Huang, Xiaoxia Li, Hui Lu, Chunming Jiang. Diagnostic value of integrated cardiopulmonary ultrasound in neonates with hypoxemia[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2019, 16(02): 102-107.

目的

探讨心肺联合超声在低氧血症新生儿病因诊断、病情监测及预后判断中的价值。

方法

选取2018年1月至2018年8月杭州市第一人民医院新生儿科收治的低氧血症新生儿45例为实验组,选取同期住院的非低氧血症新生儿20例作为对照组。所有患儿均进行超声心动图联合肺部超声检查。应用超声心动图诊断结构性疾病并评估心功能,同时使用肺部超声评分法评估肺部情况,对超声检查结果及临床病因诊断结果进行综合分析。

结果

45例低氧血症患儿临床病因有多种,包括呼吸窘迫综合征、先天性心脏病、胎粪吸入综合征、暂时性呼吸增快症、窒息后复苏等。45例低氧血症患儿中,超声心动图提示左心功能下降8例,右心功能下降1例,肺动脉高压33例;肺部超声表现为不同程度B线增多,肺局部实性变,双侧肺部评分0~30分,以13~24分者居多,单侧肺部最高评分18分。20例对照组新生儿超声心动图及肺部超声表现均未见明显异常。45例低氧血症患儿中,8例左心功能下降的患儿肺部均出现了弥漫性肺泡-间质综合征,1例右心功能下降患儿,肺部超声表现为以A线为主,单侧肺部评分2分。

结论

心肺联合超声可为低氧血症新生儿的临床病因诊断提供线索和依据,对疾病进展进行监测及预判,且具有无辐射、方便快捷、费用低廉等优势,值得临床推广应用。

Objective

To explore the value of integrated cardiopulmonary ultrasound in etiological diagnosis, disease monitoring, and prognosis evluation of neonates with hypoxemia.

Methods

Forty-five neonates with hypoxemia admitted to the Department of Neonatology, Hangzhou First People's Hospital, Zhejiang University Medical College from January to August 2018 were selected as a study group, and 20 non-hypoxic neonates who were hospitalized during the same period were selected as a control group. All the neonates underwent integrated cardiopulmonary ultrasonic examination. Echocardiography was used to diagnose structural diseases and to assess cardiac function. Pulmonary ultrasound was used to assess the condition of the lungs. The results of ultrasonography and clinical etiology were comprehensively analyzed.

Results

Of the 45 neonates with hypoxemia, the clinical causes included respiratory distress syndrome, congenital heart disease, meconium aspiration syndrome, temporary respiratory increase, post-asphyxia resuscitation and so on. In these neonates, echocardiography showed left heart failure in 8 cases, right heart failure in 1, and pulmonary hypertension in 33. Pulmonary ultrasound showed varying degrees of increased B-lines and local pulmonary consolidation. The total scores of bilateral lungs ranged from 0 to 30, with the most common scores ranging from 13 to 24, and the maximum score of unilateral lung was 18. There were no significant abnormalities of echocardiography or pulmonary ultrasound in the 20 neonates of the control group. In the study group, eight patients with decreased left ventricular function developed diffuse alveolar-interstitial syndrome in the lungs, and one case with decreased right heart function showed A-lines, with a unilateral lung score of 2.

Conclusion

Integrated cardiopulmonary ultrasound can provide clues and evidence for clinical etiology diagnosis, and monitor and predict disease progression with the advantages of no radiation, convenienience, and low cost.

图1 冠状动脉异位起源患儿超声心动图表现。图a为M型超声左心室波群,显示左心室扩大,左心室射血分数为38.9%,提示左心室收缩功能不全;图b为大动脉根部短轴切面,显示左侧冠状动脉起源于肺动脉
图2 右心功能不全患儿超声心动图表现。图a为M型超声取样线放置于三尖瓣环,测得三尖瓣环位移0.78 cm(双向箭头所示),提示右心功能不全;图b为肺部超声显示双侧肺部A线存在(箭头所示)
图3 呼吸窘迫综合征患儿肺部超声表现。肺部超声显示胸膜线不光滑,颗粒样改变(粗箭头所示),胸膜线下方小片实性变(细箭头所示)
图4 胎粪吸入患儿肺部超声表现。肺部超声显示胸膜线增厚,不光滑
图5 窒息复苏后患儿肺部超声表现。肺部超声显示B线融合,表现为肺泡-间质综合征
图6 膈疝患儿心肺联合超声表现为左肺受压实变、心脏右移、肺动脉高压。图a为左侧肺部超声显示腹腔内容物通过膈肌回声中断处(粗箭头所示)进入胸腔,肺部受压实性变,肺部评分18分;图b为右侧肺部超声显示肺部可见不均质B线(箭头所示),肺部评分10分;图c为超声心动图心尖四腔心切面显示右心明显扩大,肺动脉高压
图7 胎粪吸入患儿出生后不同时间的肺部超声表现。图a为出生后第1天肺部超声表现为以B线(粗箭头所示)为主,呈"火箭征",单侧肺部评分10分;图b为出生后第2天肺部超声表现为以A线(细箭头所示)为主,单侧肺部评分3分
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