摘要
目的评估肺脏超声对新生儿暂时性呼吸增快症（TTN）的诊断价值。方法2014年1月至12月在北京军区总医院附属八一儿童医院新生儿重症监护中心住院、并接受肺脏超声检查的患儿1358例，经病史、临床表现、动脉血气分析、胸部X线检查和肺脏超声检查，入院时无肺部病变者412例，TTN228例、呼吸窘迫综合征（RDS）358例、胎粪吸入综合征（MAS）85例、感染性肺炎215例、其他60例。在安静状态下，患儿取仰卧、侧卧或俯卧位，以腋前线和腋后线为界，将肺脏分成前、侧、后3个区域，探头与肋骨垂直或平行分别对双侧肺脏的每个区域进行扫查，并与传统胸部X线检查结果进行对照。结果TTN的主要超声特点是肺水肿，重者在超声影像上表现为白肺或致密B-线，致密B-线对诊断重度TTN的敏感性为100．0％、特异性为95．3％；轻度TTN表现为肺间质综合征或双肺点；双肺点可在轻度，TTN或其他疾病如RDS、MAS等的恢复期出现，TTN时无肺实变和支气管充气征。胸腔积液在各种肺疾病时均可出现，而胸膜线异常、A-线消失、B-线或肺间质综合征则是各种肺脏疾病的共同超声声像图表现。结论超声诊断TTN准确可靠，其主要依据是肺水肿，而无肺实变和支气管充气征，但双肺点不是TTN的特有征象，而致密B-线或白肺则是重度TTN的敏感特异性征象。
Objective To evaluate the diagnostic value of lung ultrasonography for transient tachypnea of newborn （TFN）. Methods From January to December 2014, a total of l 358 children were hospitalized in the Neonatal Intensive Care Center and underwent lung ultrasonography at the Bayi Children＇s Hospital, Beijing Military General Hospital. According to the patients＇ medical histories, clinical presentations, arterial blood gas analysis, chest X -ray examinations, and lung ultrasound examinations, there were 412 cases of patients without pulmonary lesions,228 cases of TTN ,358 cases of respiratory distress syndrome （RDS） ,85 cases of meconium aspiration syndrome （MAS） ,215 cases of infectious pneumonia,and 60 other cases at the time of hospital admission. In a resting state, the patients were placed in a supine,lateral recumbent or prone position. By using the anterior and posterior axillary lines as boundaries, the lung was divided into 3 regions：anterior,lateral, and posterior. The probe was perpendicular or parallel to the fibs, and each region of both sides of the lung was scanned. The scan results were compared to the conventional chest X - ray results. Results The main ultrasonic characteristics of TTN was pulmonary edema. In severe cases, the ultrasound showed a white lung or compact B - fine. Compact B - line had 100.0% sensitivity and 95.3% specificity for diagnosing severe TTN, Mild TYN presented as pulmonary interstitial syndrome or double lung point. Double lung point might appear during the recovery period of mild TTN or other diseases, such as RDS, MAS, and pneumonia, among others. Lung consolidation and air bronehogram were not observed in patients with TTN. Pteural effusion might occur in a variety of lung diseases, and pleural line abnormality, A - line disappearance, and B - fine or pulmonary interstitial syndrome were common ultrasonic manifestations of a variety of lung diseases. Conclusions Ultrasonic diagnosis of TTN,mainly based on pulmonary edema without lung consolidation and air bronchogram, is accuracy and reliable; however, double lung point is not a specific sign of TTN, whereas the identification of a white lung and compact B - line is a sensitive and specific sign of severe TTN.
出处
《中华实用儿科临床杂志》
CSCD
北大核心
2016年第2期93-96,共4页
Chinese Journal of Applied Clinical Pediatrics
基金
吴阶平医学基金会临床科研专项资助基金（320.6750.15072）
