肺超声评分对儿童重症肺炎病情严重程度及预后的评价效果

张乐; 许愿愿; 盛瑶; 金丹群

doi:10.7619/jcmp.20234145

肺超声评分对儿童重症肺炎病情严重程度及预后的评价效果

Evaluation efficacy of lung ultrasound score in severity and prognosis of severe pneumonia in children

摘要

摘要:
目的探讨肺部超声(LUS) 评分对儿童重症肺炎病情严重程度及预后的评价效果。
方法将2020年1月—2023年5月在安徽省儿童医院重症监护病房(ICU)收治的120例重症肺炎患儿纳入研究，治疗前后行肺超声检查、临床肺部感染评分(CPIS)、小儿危重病例评分(PCIS)、氧合指数(OI)分析，比较患儿各项指标水平。根据OI值的不同将患儿分为低危组(OI≥300, 84例)和高危组(OI < 300, 36例); 根据患儿预后分析结果，将患者分为存活组、死亡组。应用Pearson相关性分析法分析LUS评分与CPIS评分、PCIS评分、OI的相关性; 绘制受试者工作特征(ROC)曲线，计算LUS评分评价患儿预后的曲线下面积、灵敏度、特异度。
结果 120例患儿治疗后的LUS评分、CPIS评分均低于治疗前, PCIS评分、OI均高于治疗前，差异有统计学意义(P < 0.05)。低危组治疗前LUS评分、CPIS评分均低于高危组, PCIS评分、OI均高于高危组，差异有统计学意义(P < 0.05)。120例患儿中，存活87例(存活组)，死亡33例(死亡组); 存活组治疗前LUS评分、CPIS评分均低于死亡组, PCIS评分、OI均高于死亡组，差异有统计学意义(P < 0.05)。LUS评分与CPIS评分呈正相关，与PCIS评分、OI呈负相关(P < 0.05)。LUS评分评价患儿预后的曲线下面积为0.899, 灵敏度、特异度分别是0.758、0.863。
结论肺超声评分在儿童重症肺炎病情严重程度及预后评价中可发挥一定的指导作用，对患儿预后评估的灵敏度与特异度较高。

Abstract:
Objective To investigate the evaluation effect of lung ultrasound (LUS) score on the severity and prognosis of severe pneumonia in children.
Methods A total of 120 children with severe pneumonia admitted to the intensive care unit (ICU) of Anhui Provincial Children's Hospital from January 2020 to May 2023 were included in the study. Lung ultrasound examination, clinical pulmonary infection score (CPIS), pediatric critical illness score (PCIS), and oxygenation index (OI) were analyzed before and after treatment, and the levels of various indicators in children were compared. According to OI value, the children were divided into low-risk group (OI≥300, 84 cases) and high-risk group (OI < 300, 36 cases). Based on the analysis of the prognosis of the children, they were divided into survival group and death group. Pearson correlation analysis was used to analyze the correlation between LUS score and CPIS score, PCIS score, and OI. Receiver operating characteristic (ROC) curves were drawn to calculate the area under the curve, sensitivity, and specificity of LUS score in evaluating the prognosis of children.
Results After treatment, both LUS score and CPIS score of 120 cases were lower than before treatment, while PCIS score and OI were higher than before treatment (P < 0.05). Before treatment, the LUS score and CPIS score in the low-risk group were lower than those in the high-risk group, while the PCIS score and OI were higher than those in the high-risk group (P < 0.05). Among the 120 children, 87 survived(survival group) and 33 died(death group). Before treatment, the LUS score and CPIS score in the survival group were lower than those in the death group, while the PCIS score and OI were higher than those in the death group (P < 0.05). LUS score was positively correlated with CPIS score and negatively correlated with PCIS score and OI (P < 0.05). The area under the curve of LUS score in evaluating the prognosis of children was 0.899, with sensitivity and specificity of 0.758 and 0.863, respectively.
Conclusion Lung ultrasound score plays a guiding role in the evaluation of severity and prognosis of severe pneumonia in children, with high sensitivity and specificity in prognosis evaluation.

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