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目的早产儿呼吸窘迫综合征(RDS)需要做出早期诊断才能指导呼吸机和肺表面活性物质的及时使用。该研究的目的是明确胃液稳定微泡实验(stab le m icrobubb le test,SMT)早期诊断早产儿RDS的价值,为预防性使用肺表面活性物质提供指导。方法对101例收治于日本岩手医科大学新生儿重症监护室的早产儿,胎龄31±3.5周,(24~35周,)生后30 m in内取胃液做SMT,低倍镜下数出每mm2中直径<15μm的稳定微泡数;1 h内拍胸片,以临床表现及X线结果作为诊断早产儿RDS的金标准。计算SMT早期诊断早产儿RDS的敏感度、特异度及阳性、阴性预测值,观察以SMT结果指导肺表面活性物质使用的临床价值。结果101例早产儿中诊断为RDS者31例,其中微泡数<10个/mm2者22例,10~20个/mm2者7例,>20个mm2者2例;非RDS者共70例,其中<10个/mm2者仅1例,10~20个/mm2者2例,>20个mm2者67例。以胃液微泡数<10个/mm2作为界值,SMT预测并早期诊断RDS的敏感度及特异度分别为70.97%和98.57%,阳性预测值及阴性预测值分别为95.65%和88.46%;以胃液微泡数<20个/mm2作为界值,SMT预测并早期诊断RDS的敏感度及特异度分别为93.55%和95.71%,阳性预测值及阴性预测值分别为90.63%和97.10%。微泡数<10个/mm2者均接受肺表面活性物质替代治疗,临床效果显著。结论SMT法简便、快速、经济,敏感度高,特异性好,能预测并早期诊断早产儿RDS,有助于指导肺表面活性物质的预防性使用,有极高的临床应用价值,值得在国内推广。
Purpose RDS needs to be diagnosed early to guide the timely use of ventilator and pulmonary surfactant. The purpose of this study was to determine the value of early diagnosis of preterm infant RDS with stabile microtubule test (SMT), providing guidance for the prophylactic use of pulmonary surfactant. Methods 101 cases of preterm infants admitted to the Neonatal Intensive Care Unit of Iwate Medical University of Japan were enrolled in this study. The gestational age was 31 ± 3.5 weeks (24 to 35 weeks) The number of stable microbubbles with a diameter <15μm per mm2; chest radiographs within 1 h, the gold standard for the diagnosis of preterm infant RDS with clinical manifestations and X-ray findings. Calculate the sensitivity, specificity and positive and negative predictive value of SMT early diagnosis of RDS, and observe the clinical value of using SMT to guide the use of pulmonary surfactant. Results Totally 31 cases were diagnosed as RDS in 101 preterm infants. There were 22 cases of microvessel count <10 / mm2, 7 cases of 10 ~ 20 / mm2, 2 cases of> 20 mm2; 70 cases of non-RDS , Of which <10 / mm2 in only 1 case, 10 to 20 / mm2 in 2 cases,> 20 mm2 in 67 cases. The sensitivity and specificity of SMT for predicting and early diagnosis of RDS were 70.97% and 98.57%, respectively. The positive predictive value and negative predictive value were 95.65% and 88.46% respectively. The sensitivity and specificity of SMT for predicting and early diagnosis of RDS were 93.55% and 95.71%, respectively. The positive predictive value and negative predictive value were 90.63% and 97.10%, respectively. Microbubbles <10 个 / mm2 were accepted pulmonary surfactant replacement therapy, the clinical effect is significant. Conclusion The SMT method is simple, rapid, economical, sensitive and specific. It can predict and diagnose RDS in premature infants early and help guide the preventive use of pulmonary surfactant. It is of great value in clinical application. Promotion.