肺超声评分评估新生儿呼吸窘迫综合征肺病变及预后的可行性

目的：研究探讨肺超声评分评估新生儿呼吸窘迫综合征肺病变及预后的可行性。方法：研究对象：选择120例我院就诊且因呼吸困难而怀疑为呼吸窘迫综合征新生儿;病例收集时间：2017年9月~2018年10月。对120例呼吸困难新生儿实施肺部超声检查、胸部X线检查,以临床综合诊断结果为参照,计算和比较超声、X线在呼吸窘迫综合征诊断中的灵敏度、特异度、准确率,并分析诊断结果间的一致性。根据经腹肺分级标准和新生儿肺部超声图像,对新生儿肺部病变进行评分,比较呼吸窘迫综合征新生儿与非呼吸窘迫综合征新生儿的肺超声评分。再对呼吸窘迫综合征新生儿实施机械通气治疗和肺表面活性物质治疗,比较治疗前后患儿的肺超声评分。结果：120例呼吸困难新生儿中,有90例经临床综合诊断证实为呼吸窘迫综合征,其余30例非呼吸窘迫综合征,证实为暂时性呼吸增快症。以临床综合诊断结果为参照,超声在呼吸窘迫综合征诊断中的灵敏度、特异度、准确率均高于X线（P<0.05）。经一致性分析,X线诊断结果与临床综合诊断结果之间的一致性为中等（Kappa=0.607）,而超声诊断结果与临床综合诊断结果间的一致性为良好（Kappa=0.789）。在双肺、左肺、右肺、双肺底,呼吸窘迫综合征新生儿的肺超声评分均低于非呼吸窘迫综合征新生儿（P<0.05）;治疗后,呼吸窘迫综合征新生儿各部位的肺超声评分均较治疗前增高（P<0.05）。结论：超声可对新生儿的呼吸窘迫综合征予以灵敏、准确检出,且肺超声评分还可对新生儿肺部病变及预后情况予以反映,临床上可将超声作为新生儿呼吸窘迫综合征诊断、肺病变判断、预后评估的方法。     

肺部超声在新生儿呼吸窘迫综合征诊断中的应用价值

目的分析新生儿呼吸窘迫综合征（NRDS）超声评分与X线分级、临床指标的关联性,探讨肺部超声对NRDS的诊断价值。 方法收集2016年5月至2017年6月南京医科大学第一附属医院行肺部超声检查的80例新生儿,其中NRDS 44例,对患儿进行肺脏超声评分（LUS）。前胸壁和后胸壁评分的差异采用独立样本t检验;LUS与胸部X线分级的相关性采用Spearman相关分析;与氧合指数（PaO₂/FiO₂）及呼气末正压通气（PEEP）的相关性采用Pearson相关分析。 结果44例患儿的LUS总分平均为（18.89±10.43）分,后胸壁LUS平均为（8.59±3.14）分,显著高于前胸壁的（4.70±3.90）分,差异有统计学意义（P<0.05）。随着胸部X线分级越高,LUS越高,LUS与胸部X线分级呈正相关（r=0.924,P<0.05）。LUS总分与氧合指数呈负相关（r=-0.524,P<0.01）,与PEEP呈正相关（r=0.662,P<0.01）。 结论肺部超声在新生儿呼吸窘迫综合征诊断中具有一定的应用价值,LUS与胸部X线分级呈正相关,其可作为诊断新生儿呼吸窘迫综合征的重要补充。     

新生儿肺透明膜病30例临床及X线诊断分析

目的：探讨新生儿肺透明膜病（HMD）X线诊断及临床意义。方法：根据X线诊断标准及分级回顾性分析经临床及病理证实的30例HMD的X线表现。结果：本组30例,级6例,级10例,级12例,级2例。结论：胸部X线检查是诊断HMD的主要方法,细颗粒影伴支气管充气征是诊断HMD最可靠的影像表现。     

新生儿呼吸窘迫综合征30例X线影像分析

目的总结新生儿呼吸窘迫综合征（neonatal respiratory distress syndrome, NRDS）的X线胸片表现。方法啷顺性分析30例NRDS患儿床旁x线胸片影像学表现。结果30例患儿均有不同程度支气管充气征：表现为肺纹理增强、模糊15例,肺野透光度减低并可见斑片状模糊影8例,肺野均匀致密影7例;合并肺出m5例,肺炎10例,气胸2例,缺血缺氧性脑病2例,动脉导管未闭1例．胸腔积液3例。结论床旁x线胸片屉诊断新生儿NRDS的主要方法之一。     

肺超声评分评估新生儿呼吸窘迫综合征肺病变及预后的可行性及临床意义

目的 探讨肺超声评分（LUS）定量评估新生儿呼吸窘迫综合征（NRDS）严重程度及其临床意义。方法 收集74例NRDS患儿与30名对照组新生儿。对比LUS与X线检查、呼吸机辅助通气情况、呼吸机参数等临床资料。分析LUS与X线分级、辅助通气情况及呼吸机参数的相关性;应用ROC曲线评价LUS预测NRDS临床严重程度及需有创呼吸机辅助治疗的价值。结果 NRDS的肺超声表现为弥漫分布密集B线、A线消失、胸膜线异常、肺滑动征减弱、肺实变。NRDS患儿的LUS与X线分级、临床分度、辅助通气模式分级、呼吸机使用天数、呼吸机参数等呈正相关（P均<0.05）。LUS预测轻、中、重度NRDS的分值分别为13.0、22.5、29.5分。以LUS为22.5分预测患儿需应用有创辅助通气的敏感度和特异度分别为86.0%和64.5%。结论 LUS可以诊断并定量评估NRDS病情的严重程度,以指导临床诊疗。     

肺超声评分对新生儿呼吸窘迫综合征诊断价值的研究

目的:探讨双肺12区肺超声评分法在评价新生儿呼吸窘迫综合征(Neonatal respiratory distress syndrome,NRDS)严重程度中的价值。方法:通过高频超声对临床及X线确诊的60例NRDS患儿进行肺部扫查,分析肺超声影像学特点,探讨双肺12区超声B-线评分、经腹超声分级与X线分级之间的相关性。结果:双肺12区超声评分与X线分级呈显著负相关(r=-0.771,P<0.01),经腹肺超声分级与X线分级呈正相关(r=0.636,P<0.01)。X线分级多组间超声评分差异有统计学意义(F=30.34,P<0.001),Ⅰ级与Ⅱ级、Ⅱ级与Ⅲ级、Ⅲ级与Ⅳ级间超声评分差异均有统计学意义(P<0.05)。结论 :双肺12区超声评分法优于经腹超声分级,可作为NRDS患儿早期诊断、病情判断和预后观察的一种有效方法,与X线相比更直观、快速、无辐射。     

肺部超声与X线胸片在NRDS诊断中的优劣差异

目的:探讨研究肺部超声与X线在新生儿呼吸窘迫综合症(NRDS)中的诊断价值优劣性差异。方法:随机抽取2016年2018年来我院就诊54例存在呼吸窘迫症状的新生儿作为研究对象。将每名患儿先后采用X线检查与肺部超声检查,对比两种检查方法准确性,包括特异度、灵敏度等。结果:54例患儿中,以临床诊断为金标准最终诊断为NRDS患儿43例,诊断为新生儿肺炎为8例,胎儿先天性膈疝1例,其他2例。根据X线检查结果诊断出NRDS为37例,其中真阳性患儿34例,假阳性患儿3例,真阴性患儿9例,假阴性患儿8例。根据肺部超声检查结果诊断出NRDS为40例,其中真阳性患儿37例,假阳性患儿3例,真阴性患儿10例,假阴性患儿4例。肺部超声诊断与临床诊断符合率、特异度、灵敏度、阴性预测率均显著高于X线检查,差异具有统计学意义(P0.05),两种检查方法对于诊断NRDS的阳性预测率对比差异无统计学意义(P0.05)。结论:肺部超声检查比X线胸片检查在NRDS诊断中具有更高准确性和安全性,值得临床推广。     

新生儿肺透明膜病的X线表现与临床分析

新生儿肺透明膜病（new pulmonary hyaline membrance disease，NPHMD）又称新生儿呼吸窘迫综合征，为新生儿特别是早产儿死亡的主要原因，临床主要表现为呼吸困难、紫绀、三凹征等，缺少特征性，且并发症多，病程发展快，死亡率高。本文回顾分析了18例NPHMD的X线表现，以期提高其正确诊断率，现将结果报告如下。     

比较肺脏超声及X线在新生儿呼吸窘迫综合征及新生儿湿肺诊断中的价值

目的:探索新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)及新生儿湿肺(transient tachypnea of the newborn,TTN)运用肺脏超声及X线诊断的临床应用价值.方法:研究以安康市中心医院2018年9月—2021年9月收治的疑似新生...     

肺部超声与X线在新生儿呼吸窘迫综合征中的诊断价值对比研究

目的探讨肺部超声与X线胸片在新生儿呼吸窘迫综合征(NRDS)中的诊断价值。方法选取2016年1月至2017年6月该院新生儿重症监护室收治的伴有NRDS症状的新生儿198例为研究对象,对所有入选的新生儿进行肺部超声检查与X线胸片检查,以临床诊断结果为金标准,对比两种检查方法诊断NRDS与临床诊断结果的诊断符合率、特异度、灵敏度、阳性预测值、阴性预测值等。结果 198例入选患儿中,临床最终诊断为NRDS患儿132例,诊断为新生儿暂时性呼吸增快症42例,新生儿肺炎14例,其他10例;X线检查诊断为NRDS患儿120例;肺部超声诊断为NRDS患儿129例;肺部超声诊断NRDS与临床诊断符合率、特异度、灵敏度、阴性预测值均显著高于X线检查(P0.05),两种检查方法诊断NRDS的阳性预测值对比,差异无统计学意义(P0.05)。结论肺部超声诊断NRDS患儿较X线具有更高的准确率、特异度、灵敏度及阴性预测值,值得临床推广应用。     

银离子抗菌敷料治疗新生儿脐炎的疗效观察

目的 探讨银离子敷料治疗新生儿脐炎的临床疗效及安全性.方法 新生儿科收治的50例新生儿脐炎患儿,分为实验组28例,对照组22例.经常规处理后,实验组用银离子敷料(爱康肤银)换药,对照组使用莫匹罗星软膏换药.比较两组患儿换药时疼痛程度,平均治愈时间、脐部拭子细菌培养转阴时间、换药次数、单次换药时间.结果 实验组护理时患儿疼痛程度、平均治愈时间、脐部拭子细菌培养转阴时间、换药次数、单次换药时间,均低于对照组(P＜0.05).结论 银离子敷料治疗新生儿脐炎疗效显著、愈合时间短、无毒副作用;操作方法简单,值得临床进一步实践及推广应用.     

Predicting respiratory distress syndrome using gestational age and lamellar body count

ObjectivesTo design a predictive model for assessing the risk of developing respiratory distress syndrome (RDS) using gestational age (GA) and lamellar body counts (LBC).Design and methodsLBCs and patient outcome data was obtained from five medical centers. A total of 223 patients were included in this study; 19 gave birth to infants that developed RDS, 204 gave birth to infants that were unaffected. The absolute risk and odds ratios of an infant developing RDS as a function of GA and LBC were calculated. Logistic analysis was used to model the odds of RDS as a function of GA and LBC.ResultsThe odds of RDS decreased for each increasing week of GA and decreased with increase in the LBC. GA-specific LBC cutoffs are provided for sensitivities between 84 and 100%. The bias adjusted area under the ROC curve for the classification of RDS, based on GA and LBC, was 0.906 using the logistic model and 0.746 using a single cutoff of LBC (50,000/μL) to classify immaturity.ConclusionsGA-specific risk assessment and GA-specific cutoffs provide increased sensitivity and specificity in the evaluation of fetal lung maturity.     

高频震荡通气治疗新生儿呼吸窘迫综合征的护理

新生儿呼吸窘迫综合征又称早产儿肺透明膜病,是新生儿重症监护病房常见的疾病之一,主要是由于缺乏肺泡表面活性物质致使胎儿出生后肺组织不能扩张,多见于早产儿,临床上以进行性呼吸困难为主要表现。高频振荡通气（HFOV）是用于解剖死腔的潮气量,以较高的频率通过胸壁的震动产生双向压力变化从而使肺组织进行有效气体交换的机械通气方法。     

G protein-coupled receptor for asthma susceptibility associates with respiratory distress syndrome

BACKGROUND: Respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD) have some common features with asthma. AIM: To study whether G protein-coupled receptor for asthma susceptibility (GPRA) contributes to RDS or BPD. METHODS: A haplotype association study was performed in a case-control setting of 521 Finnish infants (including 176 preterm neonates with RDS and 37 with BPD). Immunoreactivity of GPRA isoforms A and B was determined in pulmonary samples of fetuses, term infants and preterm infants with RDS or BPD. GPRA mRNA expression was determined by quantitative real-time polymerase chain reaction (PCR) in samples from nasal respiratory epithelium of adults, term infants and preterm infants. RESULTS: In infants with RDS born at 32-35 weeks of gestation, GPRA haplotype H1 was significantly underrepresented in RDS, whereas haplotype H4/H5 was associated with an increased risk. As in asthma, GPRA B isoform was induced in bronchial smooth muscle cells in RDS and BPD. In nasal respiratory epithelium, relative GPRA mRNA expression was strong in adults, weak in preterm and slightly higher in term samples. CONCLUSIONS: The results suggest that near-term RDS and asthma share the same susceptibility and protective GPRA haplotypes. Altered GPRA expression may play a role in the pathogenesis of RDS and BPD in preterm infants.     

3M透明敷料固定新生儿心电监护电极片的效果观察

目的探讨3M透明敷料在新生儿心电监护电极片固定的应用效果。方法对2011年6月～2012年12月在我院新生儿科住院需要心电监护的新生儿100例，随机分成实验组和对照组。实验组用3M透明敷料固定新生儿心电监护电极片．对照组心电监护电极片直接贴在新生儿胸前皮肤上，不用3M透明敷料固定，观察两组电极片脱落的发生率。结果两组电极片脱落差异有显著意义（P〈0．01）。结论3M透明敷料固定心电监护电极片可减少电极片脱落的发生，减轻护士工作量，降低科室成本支出，提高心电监测效果，为临床治疗用药、抢救提供准确的依据，提高治疗抢救成功率。     

高锰酸钾外用片用于新生儿脐带断端消毒的临床观察

新生儿脐部是容易感染的部位,特别是出生断脐时,如果处理不当,最容易引起局部感染及出血,使脐带断端延期愈合脱落,脐带一般3～7d脱落。2008年1～9月,我科对足月正常新生儿1565例行脐带断端按常规进行消毒、结扎后按床号单双分为两组,使用高锰酸钾外用片配成浓度为20%高锰酸钾液消毒脐带断端后用新生儿甲壳素型脐带包环新生儿腹部固定,对临床效果进行对比观察,现报告如下。     

新生儿背部肩胛间测温的临床探讨

目的 :探讨新生儿背温测定的科学性与可行性。方法 :采用自身对照法测量新生儿的背温、腋温 ,对所得数据进行统计学处理。结果 :新生儿背温、腋温差异无显著性 (P >0 0 5 )。结论 :背温测量可准确反映新生儿的真实体温 ,且操作安全、简便 ,并减少了护理人员的工作量。     

22例肺硬化性血管瘤影像学分析

目的加深对肺硬化性血管瘤的认识以提高诊断水平。方法结合22例肺硬化性血管瘤患者的临床资料和文献复习，详细分析该病的病因、临床表现、诊断、鉴别诊断、治疗及预后等。结果22例中的20例被证实的硬化性血管瘤患者均行胸外手术治疗。随访时间1个月～5年不等。20例手术病人术后均无复发和转移。术中见肺内直径约1cm～6．0cm大小不等肿块，质中、光滑、包膜均完整，能完整切除。影像学检查主要表现为肺部孤立、境界清楚的结节影。结论肺硬化性血管瘤是一种少见的良性真性肿瘤，具有独特的临床病理特点，诊断有赖于计算机体层摄影术表现和组织病理学特点的结合，否则容易误诊，治疗以手术治疗为主。     

Chest radiographic course after exogenous surfactant therapy in baboons with respiratory distress syndrome

Exogenous surfactant materials have been used under a variety of treatment protocols in cases of neonatal respiratory distress syndrome (RDS). To evaluate the differences in radiologic changes that follow either an early or late therapy with exogenous bovine surfactant, we reviewed 189 serially obtained chest radiographs from 48 premature baboons with RDS studied under different treatment regimen. Twenty-six animals were controls (100 chest films), and 22 received 100 mg/kg bovine surfactant instilled via the trachea in three study protocols (89 chest films). Surfactant was given within 10 min of birth in one group and at 2 h of age in the other. In 25/26 controls, radiologic evidence of severe RDS was seen by 2 h of age; these changes persisted in 15 animals at 24 h. By contrast, a rapid clearing of radiologic features of RDS was seen following surfactant instillation in all 22 (100%) animals within 4 h, but one (4.5%) of these 22 deteriorated at 9 h of age. Pulmonary interstitial emphysema (PIE) was seen in 9/26 (34.6%) and pneumothorax in 5/26 (19.2%) control animals, while 1/22 (4.5%) surfactant-treated animals developed PIE, and none had pneumothorax. The presence of a shunt via the patent ductus arteriosus did not affect radiographic findings in 20 animals studied by contrast injection. Therapy for patent ductus arteriosus (PDA) also had no substantial influence on the radiographic findings, or with regard to the pulmonary course. Radiographic clearing of RDS occurred approximately 18 to 20 h prior to the improvement in pulmonary compliance.(ABSTRACT TRUNCATED AT 250 WORDS)     

Assessment of the diagnostic accuracy of the TDx-FLM II to predict fetal lung maturity

BACKGROUND: Because respiratory distress syndrome (RDS) affects 1% of live births, accurate and rapid assessment of markers of fetal lung maturity is critical to clinicians in deciding whether to deliver a preterm infant. Our objective was to determine the optimal diagnostic cutoff value for the TDx-FLM II assay (Abbott Laboratories) for predicting clinically significant RDS. METHODS: Amniotic fluid TDx-FLM II data were collected retrospectively over 4 years. Women were included in the study if they had delivered within 72 h of TDx-FLM II testing and both the mother and infant charts could be reviewed. Women who had been treated with steroids and delivered unaffected infants were excluded from the analysis. The diagnosis of RDS was defined as infants who either were treated with surfactant and/or were placed on a ventilator and/or required continuous positive airway pressure for >1 day. RESULTS: A total of 185 women met all entry criteria (15 RDS, 170 non-RDS). A cutoff value for a mature result of >or=45 mg/g gave a sensitivity of 100% (95% confidence interval, 82-100%) and a specificity of 90% (95% confidence interval, 78-89%). CONCLUSIONS: The TDx-FLM II appears to predict clinically significant RDS when a cutoff of >or=45 mg/g is used for mature results. Further studies will be required to confirm these findings.