高频肺部超声结合分区域扫查早期鉴别新生儿肺透明膜病及湿肺的研究

摘要 目的：探讨高频肺部超声结合分区域扫查早期鉴别新生儿肺透明膜病（HMD）及湿肺（TTN）的临床价值。方法：选取2019年1月～2020年7月因呼吸窘迫进入我院新生儿重症监护室的163例新生儿作为研究对象，患儿均接受X线和高频肺部超声检查，采用最终临床诊断作为金标准，采用受试者工作曲线（ROC）计算超声和X线诊断HMD和TTN的灵敏度、特异性、阳性预测值、阴性预测值、曲线下面积（AUC）、95％CI。结果：超声诊断HMD的灵敏度、特异性、阳性预测值、阴性预测值、AUC均高于X线检查。Z检验显示超声与X线诊断HMD的AUC存在统计学意义（Z=3.996，P=0.001）。超声诊断TTN的灵敏度、特异性、阳性预测值、阴性预测值、AUC均高于X线。Z检验显示，超声与X线诊断TTN的AUC存在统计学差异（Z=4.188，P＜0.001）。结论：高频肺部超声结合分区域扫查早期鉴别新生儿肺透明膜病及湿肺的临床价值高于X线，值得临床推广应用。

Early Differentiation of Hyaline Membrane Disease and Transient Tachypnea of the Newborn in Neonates by hHgh Frequency Pulmonary Ultrasound Combined with Regional Scanning

ABSTRACT Objective: To investigate the clinical value of high frequency pulmonary ultrasound combined with regional scanning in early differential diagnosis of hyaline membrane disease (HMD) and transient tachypnea of the newborn (TTN) in neonates. Methods: 163 newborns admitted to NICU due to respiratory distress from January 2019 to July 2020 were selected as the research objects, and all newborns underwent X-ray and high-frequency pulmonary ultrasound examination. Taking the final clinical diagnosis as the gold standard, the sensitivity, specificity, positive predictive value, negative predictive value, area under curve (AUC) and 95% CI of ultrasound and X-ray diagnosis of HMD and TTN were calculated by receiver operating curve (ROC). Results: The sensitivity, specificity, positive predictive value, negative predictive value and AUC of ultrasound diagnosis of HMD were higher than those of X-ray examination. Z test showed that AUC of ultrasound and X-ray diagnosis of HMD was statistically significant (z = 3.996, P = 0.001). The sensitivity, specificity, positive predictive value, negative predictive value and AUC of ultrasound diagnosis of TTN were higher than those of X-ray. Z-test showed that there was significant difference in AUC between ultrasound and X-ray diagnosis of TTN (z = 4.188, P < 0.001). Conclusion: The clinical value of high-frequency pulmonary ultrasound combined with regional scanning in early differential diagnosis of HMD and TTN is higher than that of X-ray, which is worthy of clinical application.