肺部超声在动态观察肺表面活性物质治疗早产儿呼吸窘迫综合征的应用价值

目的 探讨肺部超声动态观察肺表面活性物质(pulmonary surfactant, PS)治疗早产儿呼吸窘迫综合征(respiratory distress syndrome, RDS)的应用价值。方法 前瞻性选取2018年6月-2018年12月由济宁医学院附属医院产科转至新生儿重症监护病房的30例RDS早产儿,分别在PS使用前及PS使用后6h、12h、18h、24h五个时间点进行肺部超声检查并评分,观察在PS使用前后不同时间肺部超声及其评分的变化规律。结果 PS使用前,16例(53%)患儿肺部超声中表现为弥漫白肺,14例(47%)肺泡间质综合征,11例(37%)胸膜下肺实变；PS使用后6h,3例(10%)表现为弥漫白肺,2例(6.7%)可见胸膜下肺实变,较PS使用前明显好转,差异具有统计学意义(c²分别为11.09、6.29,P分别为0.001、0.012)。在PS使用后12h、18h、24h,所有患儿肺部超声均未见弥漫白肺、肺实变,与PS使用前比较,差异具有统计学意义(c²=19.18,P＜0.001),但相比PS使用后6h,差异无统计学意义(c²=1.40,P=0.24)。进一步使用肺部超声评分进行分析,PS使用后6h、12h、18h、24h超声评分分别为19.3±4.0、17.4±3.9、17.6±4.0、17.9±4.2,较PS使用前超声评分22.3±2.6,差异具有统计学意义(P均＜0.05),而PS使用后6h、12h、18h、24h之间的超声评分差异不大,无统计学意义(P均＞0.05)。结论 肺部超声可以动态观察PS对RDS的治疗效果,在使用PS后6h,肺部超声即可以发现肺部病变较前明显好转。

The value of lung ultrasound to observe pulmonary surfactant dynamically in the treatment of respiratory distress syndrome in preterm neonates

Objective To investigate the value of lung ultrasound in the dynamic observation of pulmonary surfactant (PS) in the treatment of respiratory distress syndrome(RDS) in premature infants. Methods Thirty preterm infants diagnosed with RDS were transferred from our obstetrics department to the neonatal intensive care unit from June to December 2018 prospectively. Lung ultrasound was performed and scored before and after PS use at 6h, 12h, 18h, and 24h. The aim was to observe the effect of PS on preterm neonates with RDS and the dynamic change of lung ultrasound at different times. Results Before the use of PS, 16 cases (53%) of the children showed bilateral white lung in lung ultrasound, 14 cases (47%) of alveolar interstitial syndrome, and 11 cases (37%) of subpleural lung consolidation; after 6 hours of PS use, 3 cases (10%) showed bilateral white lung, and 2 cases (6.7%) showed subpleural lung consolidation, which was significantly better than that before PS use, and the difference was statistically significant (c² were 11.09 and 6.29, respectively; P was 0.001 and 0.012, respectively). At 12h, 18h, and 24h after PS use, bilateral white lung and lung consolidation were not seen in the lung ultrasound of all preterm neonates with RDS. Compared with that before PS, the difference was statistically significant (c² = 19.18, P <0.001), but the difference was not statistically significant compared with that at 6 hours after PS use (c² = 1.40, P = 0.24). Further, lung ultrasound score was used for analysis. The lung ultrasound score at 6h, 12h, 18h, and 24h after PS was 19.3 ± 4.0, 17.4 ± 3.9, 17.6 ± 4.0, and 17.9 ± 4.2, respectively, which was lower than that before PS use. And the difference was statistically significant (all P< 0.05). However, the differences of lung ultrasound score at 6h, 12h, 18h, and 24h after PS use were not statistically significant (all P> 0.05). Conclusion Lung ultrasound can dynamically evaluate the effect of PS in the treatment of preterm neonates with RDS. After 6 hours of PS, the pulmonary condition can be improved significantly.