肺超声评分对NRDS合并BPD的预测价值研究.docx

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1、肺超声评分对NRDS合并BPD的预测价值研究杨朵,刘梦梅2,魏玉秀方1 .西安市中心医院新生儿科陕西西安7100042 .西安国际医学中心医院超声诊疗中心陕西西安710061通讯作者：魏玉秀，主治医师，邮箱：【摘要】目的探讨肺超声评分对新生儿呼吸窘迫综合征(NRDS)合并支气管肺发育不良(BPD)的临床预测价值。方法回顾性分析2019年6月至2023年7月在本院接受治疗且被诊断为NRDS的102例患儿的临床资料，收集患儿一般资料以及临床检查结果，并根据患儿是否合并BPD分为两组，观察组为NRDS合并BPD的患儿42例，对照组为非BPD组60例。比较两组肺超声评分和临床资料的差异。对出生后12d

2、肺超声评分与胸部X线、血气氧合指数进行SPearman相关分析，并采用受试者工作特征(ROC)曲线评价不同时间点的肺超声评分对NRDS合并BPD的预测价值结果观察组的APgar评分、胎抬、出生体质量、血气氧合指数评分分别为(5.781.19)分、(2923356)病、(1327.2321682)g,(135.3527.16)mmHg,明显低于对照组的【(7.231.23)分、(33.845.36周(I933.65257.72)g、(I74.389.18)mmHg,观察组住院时间为(62.2023.45)d,明显长于对照组的(42.7313.12)d】，差异均具有统计学意义(P0.05)两组胸部

3、X线分级相比，差异具有统计学意义(P0.05)观察组出生后12d,出生后第1周末、出生后第3周末的肺部超声评分分别为(42.466.78)分、(35.885.93)分、(11.765.54)分、(25.325.44)分,均显著高于对照组(37.486.04)分、(31325.53)分、(26.384.73)分、(20.874.36)分】，差异有统计学意义(P005).出生后12d的肺超声评分与胸部X线分级、血气氧合指数呈相关关系(r=0.780,-0.897,P0.05)o肺部超声评分在不同时间点预测NRDS合并BPD的ROC曲线下面积分别为0.570(95%C10.5100.943)、0.6

4、63(95%CK).553-0.797)、0.764(95%CI0.723).858)0.864(95%C10.845-0.967)：肺部超声评分出生后12d,出生后第I周末、出生后第3周末的特异性分别为813%、81.2%95.2%、92.0%,敏感性分别为48.2%、57.6%,72.6%、67.2%。结论肺超声评分在评估NRDS合并BPD的病情评估中具有较好的临床预测价值，具有较高的敏感性和特异性。【关键词】肺脏超声：新生儿：呼吸窘迫综合征：支气管肺发育不良：预测价值Xstudyofthepredictiveva1ueof1ungu1trasoundscoringonNRDScombin

5、edwithBPDYang-Duo1,1i1bMengmei2,Wei-Yuxiu2*1XianCentra1Hospita1DepartmentOfNeonaie,ShaanxiXian7100042.U1trasoundC1inicXianIniemationa1Medica1CenterHospita1.ShaanxiXian710061AbstractObjectiveIbinvestigatethec1inica1predictiveva1ueof1ungu1trasoundscoringinneonata1respiratorydistresssyndrome(NRDS)withb

6、ronchopu1monarydysp1asia(BPD).MethodsAretrospectiveana1ysiswasconductedonthec1inica1dataof102chi1drenwhoreceivedtrea1mcntinthishospita1fromJune2019toJu1y2023andwerediagnosedwithNRDS,and1hegenera1dataandc1inica1examinationresu1tswereco11ected,andthechi1drenweredividedintotwogroupsaccordingtowhetherth

7、echi1drenhadBPD.42chi1drenwithNRDSandBPDwereobserved,and6()caseswerenon-BPDinthecontro1group.Thedif1crcnccsin1ungu1trasoundscoresandc1inica1datawerecomparedbetweenthetwogroups.Thepredictiveva1ueof1ungu1trasoundscoresonNRDScombinedBPDwaseva1uatedusingthesubjectworkcharacteristic(ROC)curve.Spcaman-rc1

8、atcdana1ysisof1ungu1trasoundscoreandchestX-rayandb1(xigasoxygenationindexfor1-2daysafterbirth,characteristic(ROC)cun,ewasusedtoeva1uatethepredictiveva1ueof1ungu1trasoundscoresonNRDScombinedBPDatdifferenttimetsApgarscore.ge*4tHieH1-ttgerbirthbodymass,andb!dgasoxygenationindexscoresoftheobservationgro

9、upwere(5.781.19)points,f256wtfek.(1327.23216.82)g,(135.3527.I6)mmHg,respective1y,significant1y1owerthanthecontro1groups(7.231.23)points.(-845.-6)week.(1933.65257.72)g,(174.389.18)mmHg,theobservationgrouphadahospita1stayof(62.2O23.45)d,whichwassignificant1y1ongerthanthatofthecontro1group(42.7313.12)d

10、,thedifferenceswerestatistica11ysignificant(P0.05).ThedifferencebetweenthetwogroupsofchestX-raygradeswasstatistica11ysignicant(P0.05).Theobservationgrouphadpu1monaryu1trasoundscoresfromIto2daysafterbirthand3daysafterbirth,respective1y,(42.466.78)points.(35.885.93)points,(11.765.54)points,and(25.325.

11、44)points,whichweresignificant1yhigherthanthoseofthecontro1group(37.486.04)points,(31.325.53)points,(26.384.73)points,and(20.874.36)pointsJ,thedifferencewasstatistica11ysignificant(P0.05).The1ungu1trasoundscore1-2daysafterbirthwascorre1atedwithchestX-raygradingandb1oodgasoxygenationindex(r=().780,-0

12、.897,P28d,病历资料完整；经医院伦理委员会讨论通过!，患儿家属同意。排除标准：先天性胸部畸形、精神疾病、严重先天性心脏病；具有引起呼吸窘迫的其他疾病；已接受肺活性物等治疗者。根据患儿是否合并BPD分为两组，观察组为NRDS合并BPD的患儿42例，对照组为非BPD组60例。其中观察组男18例，女24例；对照组男27例，女23例；两组差异无统计学意义(PX).05)。12方法1.2.1资料收集：收集两组患儿性别、出生体质量、机械通气时间、APgar评分等资料以及两组患儿X线胸部检查、血气氧合指数情况。1.2.2肺部超声检查：采用Phi1iPSCX50便携式超声诊断仪器，高频线阵探头，频率713MHz。在患儿出生2d内，运用双肺12区评分法分别进行肺超声评分，让患儿平躺或