肺脏超声评价儿童重症肺炎疗效的应用分析

目的:探讨肺脏超声（LUS）评价儿童重症肺炎（SP）疗效的应用价值。方法:选取142例儿童SP患者，回顾性根据临床疗效判断标准分为治愈组75例、好转组49例、无效组18例。分别于入院时、入院第7天和第15天对所有患儿行LUS及X线片检查，观察3组患儿肺部征象，并进行LUS评分。入院第15天时，采用临床肺部感染评分（CPIS）评估3组肺部感染情况，采用血气分析仪检测肺泡-动脉氧分压差（A-aDO2）及氧合指数（OI）水平，采用Pearson相关系数分析入院第15天LUS评分与CPIS、A-aDO2和OI的关系。结果:入院第7天和第15天治愈组患儿LUS评分、坐位B线数和平卧位B线数均少于好转组和无效组（P<0.05）。治愈组患儿胸膜线异常和A线消失率低于好转组和无效组（P<0.05）。治愈组患儿入院时和入院第7天胸腔积液LUS检出率高于X线片（P<0.05），无效组患儿入院时和入院第15天LUS胸腔积液检出率高于X线片（P＜0.05）。治愈组患儿CPIS和A-aDO2水平低于好转组和无效组（P<0.05），OI水平高于好转组和无效组（P<0.05）。Pearson相关性分析结果显示，入院第15天LUS评分与CPIS和A-aDO2呈正相关（P<0.05），与OI呈负相关（P<0.05）。结论:LUS及LUS评分能够有效评估儿童SP的临床疗效，且胸腔积液检出率更高，具有较高的临床应用价值。 【关键词】肺脏超声；儿童；重症肺炎；肺脏超声评分；临床疗效

Evaluating the treatment outcome of severe pneumonia in children by lung ultrasound

Abstract: Objective To explore the feasibility of lung ultrasound (LUS) in evaluating the treatment outcome of severe pneumonia (SP) in children. Methods According to the criteria for evaluation of clinical efficacy, a total of 142 children with SP were divided into healing group (75 cases), improvement group (49 cases) and ineffective group (18 cases). At admission, 7 d and 15 d after admission, all underwent LUS and X-ray examinations for observing lung signs and LUS scoring. At 15 d after admission, clinical pulmonary infection score (CPIS) was used for assessing lung infection, blood gas analyzer for detecting alveolar -arterial gradient of oxygen (A-aDO2) and oxygenation index (OI), and Pearson correlation coefficient for analyzing the relationships between LUS score at 15 d after admission and CPIS, A-aDO2, OI. Results At 7 d and 15 d after admission, compared with the other two groups, healing group had lower LUS scores, less B-lines in sitting and supine positions, and lower incidence rates of abnormal pleural line and A-line disappearance (P<0.05). The detection rate of pleural effusion by LUS was higher than that by X-ray film in healing group at admission and 7 d after admission (P<0.05), and in ineffective group at admission and 15 d after admission (P<0.05). The CPIS and A-aDO2 in healing group were lower than those in improvement group and ineffective group (P<0.05), while OI level was higher (P<0.05). The results of Pearson correlation analysis showed that LUS score at 15 d after admission was positively correlated with CPIS and A-aDO2 (P<0.05), while negatively correlated with OI (P<0.05). Conclusion LUS and LUS score can effectively evaluate treatment outcome of SP in children, and the detection rate of pleural effusion by LUS is higher, which is of higher clinical application value.