Application value of point-of-care lung ultrasound scoring in selecting respiratory support treatment for neonatal infectious pneumonia
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摘要:目的
探讨床旁即时肺部超声(POC-LUS)评分在新生儿感染性肺炎(NIP)患儿呼吸支持治疗方式选择中的应用价值。
方法选取89例NIP患儿作为研究对象，根据呼吸困难程度及血气分析结果分为对照组(无辅助通气)46例、无创组(无创辅助通气)28例、有创组(有创机械通气)15例。比较3组患儿的POC-LUS评分，并分析POC-LUS评分与动脉血氧分压[pa(O2)]、动脉血二氧化碳分压[pa(CO2)]的相关性。绘制受试者工作特征(ROC)曲线，评估POC-LUS评分对NIP患儿需要无创辅助通气或有创机械通气治疗的预测效能。
结果无创组、有创组的POC-LUS评分依次为(31.7±7.3)、(42.1±8.0)分，高于对照组的(21.5±7.3)分，且有创组评分高于无创组，差异有统计学意义(P < 0.05)。相关性分析结果显示, POC-LUS评分与pa(O2)呈显著负相关(r=-0.802, P < 0.05), 与pa(CO2)呈显著正相关(r=0.807, P < 0.05)。ROC曲线分析结果显示, POC-LUS评分预测患儿需要无创辅助通气、有创机械通气的曲线下面积(AUC)分别为0.918(95%CI: 0.862~0.973)、0.938(95%CI: 0.889~0.987), 敏感度分别为0.767、0.933, 特异度分别为0.935、0.824, 最佳截断值为29.5、31.5分。
结论POC-LUS评分可量化评估NIP患儿肺部病变严重程度，对临床医师选择辅助通气治疗方式具有指导作用。
Abstract:ObjectiveTo investigate the application value of point-of-care lung ultrasound (POC-LUS) scoring in selecting respiratory support treatment modalities for neonatal infectious pneumonia (NIP).
MethodsA total of 89 NIP patients were selected as the study subjects and divided into control group (no assisted ventilation) with 46 cases, noninvasive group (noninvasive assisted ventilation) with 28 cases, and invasive group (invasive mechanical ventilation) with 15 cases based on the degree of dyspnea and blood gas analysis results. The POC-LUS scores of the three groups were compared, and the correlations of POC-LUS scores with arterial oxygen partial pressure [pa(O2)] and arterial carbon dioxide partial pressure [pa(CO2)] were analyzed. Receiver operating characteristic (ROC) curves were plotted to assess the predictive efficacy of POC-LUS scores for the need for noninvasive assisted ventilation or invasive mechanical ventilation in NIP patients.
ResultsThe POC-LUS scores of the noninvasive group and the invasive group were (31.7±7.3) and (42.1±8.0), respectively, which were higher than (21.5±7.3) of the control group. Additionally, the score of the invasive group was higher than that of the noninvasive group (P < 0.05). Correlation analysis revealed a significant negative correlation between POC-LUS scores and pa(O2) (r=-0.802, P < 0.05), and a significant positive correlation with pa(CO2) (r=0.807, P < 0.05). ROC curve analysis showed that the area under the curve (AUC) of POC-LUS scores for predicting the need for noninvasive assisted ventilation and invasive mechanical ventilation were 0.918 (95%CI, 0.862 to 0.973) and 0.938 (95%CI, 0.889 to 0.987), respectively. The sensitivity was 0.767 and 0.933, and the specificity was 0.935 and 0.824, with optimal cutoff values of 29.5 and 31.5, respectively.
ConclusionPOC-LUS scoring can quantitatively assess the severity of lung lesions in NIP patients and serves as a guiding tool for clinicians in selecting assisted ventilation treatment modalities.
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表 1 3组患儿一般资料比较(x±s)[n(%)]
一般资料 对照组(n=46) 无创组(n=28) 有创组(n=15) 性别 男 29(63.0) 19(67.9) 9(60.0) 女 17(37.0) 9(32.1) 6(40.0) 出生体质量/g 2 316.5±793.9 2 186.7±635.8 2 190.0±754.7 胎龄/d 215.5±18.6 222.6±14.4 217.0±13.0 脉率/(次/min) 138.9±9.7 144.4±9.1* 163.9±11.4*# 呼吸频率/(次/min) 48.7±7.7 53.0±6.9* 71.9±12.3*# pa(O2)/mmHg 78.9±17.7 47.0±5.7* 50.1±19.0* pa(CO2)/mmHg 27.9±13.1 29.5±6.3 59.9±13.3*# pH值 7.37±0.06 7.37±0.06 7.15±0.05*# pa(O2): 动脉血氧分压; pa(CO2): 动脉血二氧化碳分压。与对照组比较, * P < 0.05; 与无创组比较, #P < 0.05。 
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