肺脏超声对新生儿与儿童肺疾病诊断价值研究

发布时间：2018-04-04 02:14

本文选题：肺脏超声　切入点：儿童　出处：《南方医科大学》2017年博士论文

【摘要】：研究背景肺部疾病是新生儿与儿童最常见的疾病,也是5岁以下儿童第一位的死亡原因。因此对它的诊断和监测是极其的重要。一直以来,胸部X线和CT是呼吸道疾病的主要诊查手段,但是它们都有各自不可避免的缺点。近年来,随着对肺脏超声认识的加深,发现肺脏超声可以弥补它们的不足。肺脏超声能够快速发现肺部的病灶,从而能够及时调整治疗的策略。但是肺脏超声在新生儿和儿童中仍没有得到广泛的应用,尤其在我国更是如此,因此本课题主要研究肺脏超声对新生儿与儿童肺疾病诊断的价值。第一部分:新生儿与儿童正常肺脏超声影像学探讨目的探讨正常新生儿和儿童肺脏超声影像学的特点。方法对无肺脏疾病新生儿和儿童共795例实施肺脏超声检查。结果正常儿童的超声征象为胸膜线和A-线,无B-线及其它异常的超声征象;而新生儿肺部主要存在胸膜线、A-线,并可见B-线或彗星尾征。无肺疾病新生儿有713例(95.4%)在生后3天内见到B-线,256例(34.3%)生后3天～1周可见到B-线,19例(2.5%)生后1～2周可见B-线。结论新生儿肺部B-线可以较长时间的存在,存在时间的长短与其生理状态有关。第二部分:肺脏超声对新生儿肺疾病的诊断价值目的研究肺脏超声对新生儿肺疾病的诊断价值。方法对患有肺脏疾病的2658例新生儿实施肺脏超声检查。结果NICU肺部疾病的主要超声征象为A-线消失、胸膜线异常、肺间质综合征、肺实变、肺水肿、肺搏动等,随着病情恢复,上述征象逐渐减轻至消失。结论肺脏超声对新生儿肺疾病诊断准确,尤其对RDS与TTN的诊断与鉴别、对肺不张的诊断、对早产儿长期氧依赖的病因判别等更具有实用价值。第三部分:肺脏超声对儿童肺疾病的诊断价值目的研究肺脏超声对儿童肺疾病的诊断价值。方法对患有儿童重症监护室137例儿童实施肺脏超声检查。结果儿童重症监护室肺部疾病的主要超声征象为A-线消失、胸膜线异常、肺实变、肺间质综合征等。在撤呼吸机失败病例中,肺脏超声比X线更容易发现病灶。结论肺脏超声对儿童肺部疾病诊断准确,尤其对病情反复及撤呼吸机失败的病人等更具有实用价值。第四部分:肺脏超声诊断肺疾病与胸部X线的比较目的探讨肺脏超声与X线在诊断和监测肺疾病方面的优劣。方法患肺部疾病的1692例新生儿和137例儿童同时接受肺脏超声和胸部X线检查。结果在新生儿和儿童重症监护室中,肺脏超声和X线两者对肺疾病检查的结果均存在明显的统计学差异。结论肺脏超声比传统的X线更容易发现肺间质综合征、肺不张等这些潜在的隐匿性病变,有利于临床的诊疗。
[Abstract]:Background Pulmonary disease is the most common disease in newborns and children and the first cause of death in children under 5 years of age.Therefore, it is extremely important to diagnose and monitor it.Chest X-ray and CT are the main diagnostic methods for respiratory diseases, but they have their own inevitable disadvantages.In recent years, with the deepening of the understanding of lung ultrasound, we found that lung ultrasound can make up for their shortcomings.Lung ultrasound can quickly detect pulmonary lesions and thus adjust treatment strategies in time.However, pulmonary ultrasound has not been widely used in newborns and children, especially in China. Therefore, the value of pulmonary ultrasound in the diagnosis of neonatal and childhood lung diseases is studied in this paper.Part one: ultrasonic Imaging of normal Lung in Neonates and Children objective to explore the characteristics of ultrasonic imaging in normal neonates and children.Methods Pulmonary ultrasonography was performed in 795 neonates and children without pulmonary disease.Results the ultrasonic signs of normal children were pleural line and A- line, no B-line and other abnormal ultrasound signs, while the main signs of pleural line A- line were found in the lungs of newborns, and the B-line or comet sign could be seen.There were 713 cases of newborns without pulmonary disease (795. 4) within 3 days after birth, 256 cases of B- thread were seen and 3 days after birth, there were 19 cases of B- line and 2. 5) B- line could be seen 1 ~ 2 weeks after birth.Conclusion the B-line of newborn lung can exist for a long time, and the duration of existence is related to its physiological state.Part two: diagnostic value of pulmonary ultrasound in neonatal lung disease objective to study the diagnostic value of pulmonary ultrasound in neonatal lung disease.Methods 2658 neonates with pulmonary diseases were examined by ultrasound.Results the main signs of NICU pulmonary disease were disappearance of A- line, abnormal pleural line, pulmonary interstitial syndrome, pulmonary consolidation, pulmonary edema, pulsatility and so on.Conclusion Pulmonary ultrasound is more valuable in the diagnosis of neonatal pulmonary diseases, especially in the diagnosis and differential diagnosis of RDS and TTN, in the diagnosis of atelectasis, and in the etiology of long-term oxygen dependence of premature infants.Part three: diagnostic value of Pulmonary Ultrasound in Children with Pulmonary Disease objective to study the diagnostic value of Pulmonary Ultrasound in Children with Pulmonary Disease.Methods 137 children with children in intensive care unit were examined by pulmonary ultrasound.Results the main signs of pulmonary diseases in ICU were disappearance of A-line, abnormal pleural line, pulmonary consolidation, pulmonary interstitial syndrome and so on.Pulmonary ultrasound was more likely than X-ray to detect lesions in failed ventilator withdrawal.Conclusion Pulmonary ultrasound has more practical value in the diagnosis of pulmonary diseases in children, especially in patients with repeated illness and failure of ventilator withdrawal.Part IV: the comparison of pulmonary diseases with chest radiography objective to investigate the advantages and disadvantages of lung ultrasound and X-ray in the diagnosis and monitoring of lung diseases.Methods 1692 neonates and 137 children with pulmonary diseases were examined by both ultrasound and chest X-ray.Results in neonatal intensive care unit and children's intensive care unit, the results of pulmonary ultrasound and X-ray examination of lung diseases were significantly different.Conclusion Pulmonary interstitial syndrome, atelectasis and other latent occult lesions can be found more easily by ultrasound than traditional X ray, which is beneficial to clinical diagnosis and treatment.
【学位授予单位】：南方医科大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R722.1;R725.6

【相似文献】