中国实用儿科杂志

中国实用儿科杂志

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肺脏超声对重症监护病房患儿应用价值分析

  

  1. 1.北京军区总医院附属八一儿童医院ICU，北京  100730； 2.深圳市宝安区妇幼保健院儿科，广东  深圳  518133
  • 出版日期:2016-09-06 发布日期:2016-09-09

Application of findings of lung ultrasonography examinations in Pediatric Intensive Care Unit

  1. Department of Intensive Care Unit，Bayi Children’s Hospital，Beijing Military General Hospital，Beijing  100700，China
  • Online:2016-09-06 Published:2016-09-09

摘要：

目的    研究肺脏超声在儿童重症监护病房（PICU）中的应用特点及其临床价值。方法　对2015年5月1日至2015年8月31日就诊于北京军区总医院附属八一儿童医院的内科ICU和心外科ICU的137例患儿进行肺脏超声检查。肺疾病诊断依据病史、临床表现、实验室检查及胸部X线和（或）CT检查，与肺脏超声检查结果进行对照比较。结果　137例中存在肺疾病者89例（66.7％）；无肺部疾病者48例（33.3%）。肺疾病中肺炎76例（85.4％）、毛细支气管炎8例（9.0%）、急性呼吸窘迫综合征5例（5.6％）。肺疾病的主要超声征象为A-线消失、胸膜线异常、肺实变、肺间质综合征、肺搏动、肺水肿等。肺脏超声动态观察发现，病情的好转、加重或是新出现的肺部感染，均可通过胸膜线、A-线、肺间质综合征、肺实变、肺不张、支气管充气征等超声征象来判断。在撤呼吸机失败病例中，肺脏超声比X线更容易发现病灶。无肺脏疾病儿童肺脏超声中可见正常的胸膜线和A-线，无B-线、肺间质综合征、肺实变、支气管充气征等异常征象。结论　肺脏超声对PICU肺部疾病诊断准确，尤其对病情反复及撤呼吸机的患儿更具有实用价值；超声检查便于动态监测疾病变化，提示在PICU内常规开展肺脏超声检查具有可行性及必要性。

关键词: 儿童, 婴儿, 肺脏超声, 肺部疾病, 重症监护室

Abstract:

Objective    To study the features of lung ultrasonography（LUS） in lung diseases and evaluate the value of LUS in pediatric intensive care unit（PICU）. Methods    Totally 137 children hospitalized from May 1，2015 to August 31，2015，in pediatric intensive care unit of Bayi Children’s Hospital， General Hospital of Beijing Military Command， were included in this study. All the children were examined by LUS and diagnosed by medical history， clinical manifestation， laboratory examination， signs of X-ray or chest CT. The results of LUS were compared with them. Results    There were 89 cases（66.7%） who were lung diseases and 48 cases（33.3%） without lung diseases. The cases with lung diseases were as follows： 76 cases（85.4%） with pneumonia， 8 cases（9.0%） with  capillary bronchitis and 5 cases（5.6%） with acute respiratory distress syndrome（ARDS）. The main characteristics of children with lung diseases on LUS were as follows： A-lines disappearance， pleural line abnormalities， lung consolidation， interstitial syndrome， lung pulse and pulmonary edema. The signs of pleural line， A-lines， lung consolidation， interstitial syndrome， pulmonary edema and lung pulse could be used to monitor the conditions of children with lung diseases. Futhermore， compared with by X-ray， it was much easier to find the lesions of patients by LUS who failed to be withdrawn ventilator. The features of LUS in children with no lung diseases included pleural line and A-lines，but did not include abonormal signs of B-lines， interstitial syndrome and lung consolidation. Conclusion    The diagnosis of LUS is precise in lung diseases. LUS has more practical value， especially for patients with condition waving， and those with withdrawing of mechanical ventilation. Moreover， LUS has more advantages， including no radiation and monitoring the diseases on bed without interfering the treatment. Therefore， it is necessary that LUS should be routinely used in PICU.

Key words: child, infant, lung ultrasonography, lung diseases, Intensive Care Unit