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[新生儿肺部超声检查]

[Lung ultrasound in the newborn].

作者信息

Yousef N

机构信息

Service de réanimation néonatale, hôpital Antoine-Béclère, hôpitaux universitaires Paris-Sud, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; Service de réanimation pédiatrique et néonatale, hôpital Bicêtre, hôpitaux universitaires Paris-Sud, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.

出版信息

Arch Pediatr. 2016 Mar;23(3):317-21. doi: 10.1016/j.arcped.2015.12.001. Epub 2016 Feb 12.

Abstract

Lung ultrasound (LU) is becoming a bedside point-of-care technique in critical care and emergency medicine as it is performed and immediately interpreted by the clinician. LU is quick, easy, relatively inexpensive, and provides accurate diagnostic information when compared with conventional lung imaging methods, such as CT scans and chest radiographs, with the additional advantage of being non-irradiating, adapted to bedside use, and easily repeatable with no side effects for the patient. LU is easy to learn, does not require sophisticated ultrasound machines or settings, and shows low intra- and interobserver variability when a standardized approach is used. A comprehensive and standardized ultrasound semiology has been described and validated in both adults and children. In summary, LU allows for quick easy recognition of a normally aerated lung in contrast to an interstitial or alveolar pattern. Recognition of these patterns may be even easier in neonates due to their small size and the absence of obesity and heavy musculature. Specific LU findings have been described for some types of neonatal lung injury, such as neonatal respiratory distress syndrome, transient tachypnea of the neonate, meconium aspiration syndrome, and neonatal pneumonia. In the newborn, LU has proved its usefulness in predicting the need for hospital admission and/or intubation based on simple LU patterns. A recently proposed LU score, adapted for the neonate, correlates well with oxygenation status, independently of gestational age and underlying respiratory condition. The score reliably predicts the need for surfactant treatment in preterm babies less than 34 weeks gestation treated with nasal CPAP from birth. LU is a promising tool with numerous potential applications that warrant future studies. However, like every technique, LU has its limitations and should not completely replace standard radiography. LU can nevertheless largely reduce exposure to ionizing radiation by limiting the use of conventional radiographs to a strict minimum.

摘要

肺部超声(LU)正成为重症监护和急诊医学中的一种床旁即时诊断技术,因为临床医生可即时操作并解读。与传统肺部成像方法(如CT扫描和胸部X光片)相比,肺部超声快速、简便、相对便宜,且能提供准确的诊断信息,还具有无辐射、适用于床旁使用、可轻松重复且对患者无副作用的额外优势。肺部超声易于学习,不需要复杂的超声设备或设置,使用标准化方法时,观察者内和观察者间的变异性较低。一种全面且标准化的超声影像学已在成人和儿童中得到描述和验证。总之,与间质或肺泡模式相比,肺部超声可快速轻松地识别正常通气的肺。由于新生儿体型小、无肥胖和肌肉发达等情况,识别这些模式可能更容易。已针对某些类型的新生儿肺损伤(如新生儿呼吸窘迫综合征、新生儿短暂性呼吸急促、胎粪吸入综合征和新生儿肺炎)描述了特定的肺部超声表现。在新生儿中,肺部超声已证明其基于简单的肺部超声模式预测住院和/或插管需求的有用性。最近提出的适用于新生儿的肺部超声评分与氧合状态密切相关,与胎龄和潜在呼吸状况无关。该评分可靠地预测了出生后接受鼻持续气道正压通气(CPAP)治疗的孕34周以下早产儿对表面活性剂治疗的需求。肺部超声是一种有前景的工具,有许多潜在应用值得未来研究。然而,与每种技术一样,肺部超声也有其局限性,不应完全取代标准放射学检查。不过,肺部超声通过将传统X光片的使用严格限制在最低限度,可大幅减少电离辐射暴露。

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