腹部超声有助于坏死性小肠结肠炎的诊断和治疗。

Abdominal Ultrasound Assists the Diagnosis and Management of Necrotizing Enterocolitis.

机构信息

Neonatology Division, University of Utah, Salt Lake City (Drs Chan and Yang); Diagnostic Imaging, Intermountain Healthcare, Salt Lake City, Utah (Ms Gordon and Dr Dance); and University of Utah School of Medicine, Salt Lake City (Ms Weekes).

出版信息

Adv Neonatal Care. 2021 Oct 1;21(5):365-370. doi: 10.1097/ANC.0000000000000919.

DOI:10.1097/ANC.0000000000000919

PMID:34469367

Abstract

BACKGROUND

Abdominal x-ray (KUB) routinely aids in detecting necrotizing enterocolitis (NEC), one of the most serious neonatal intestinal diseases. However, a KUB may miss up to 50% of the early signs of NEC. Recent advances in abdominal ultrasound (AUS) can expedite this diagnosis and improve clinical management.

PURPOSES

To illustrate AUS findings that suggest NEC through 3 case examples. To review current literature regarding advantages and limitations of AUS compared with KUB.

RESULTS

The added visualization of intra-abdominal structures with AUS compared with KUB improves the diagnosis and management of NEC. Some AUS features are highly suggestive of impending bowel perforation, while others can confirm bowel perforation despite a negative radiograph.

IMPLICATIONS FOR PRACTICE

AUS expedites time to diagnosis of NEC and helps to stratify patients who may fail medical management and require surgical intervention.

IMPLICATIONS FOR RESEARCH

More quality improvement studies are needed to validate an AUS protocol for the management of NEC. Advances in technology, such as contrast-enhanced ultrasound, may improve NEC detection with AUS in the future.Video Abstract available athttps://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx.

摘要

背景

腹部 X 光（KUB）常规用于检测坏死性小肠结肠炎（NEC），这是新生儿最严重的肠道疾病之一。然而，KUB 可能会错过多达 50%的 NEC 早期迹象。腹部超声（AUS）的最新进展可以加快这一诊断，并改善临床管理。

目的

通过 3 个病例示例说明提示 NEC 的 AUS 发现。回顾 AUS 与 KUB 相比在诊断和局限性方面的现有文献。

结果

与 KUB 相比，AUS 对腹腔内结构的额外可视化提高了 NEC 的诊断和管理水平。一些 AUS 特征高度提示即将发生肠穿孔，而其他特征即使 X 线片阴性也可以确认肠穿孔。

对实践的意义

AUS 加快了 NEC 的诊断时间，并有助于对可能无法通过药物治疗而需要手术干预的患者进行分层。

对研究的意义

需要更多的质量改进研究来验证 AUS 协议在 NEC 管理中的应用。未来，技术的进步，如对比增强超声，可能会提高 AUS 检测 NEC 的能力。视频摘要可在以下网址获得：https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx。