论文部分内容阅读
目的研究肺脏超声在儿童重症监护病房(PICU)中的应用特点及其临床价值。方法对2015年5月1日至2015年8月31日就诊于北京军区总医院附属八一儿童医院的内科ICU和心外科ICU的137例患儿进行肺脏超声检查。肺疾病诊断依据病史、临床表现、实验室检查及胸部X线和(或)CT检查,与肺脏超声检查结果进行对照比较。结果 137例中存在肺疾病者89例(66.7%);无肺部疾病者48例(33.3%)。肺疾病中肺炎76例(85.4%)、毛细支气管炎8例(9.0%)、急性呼吸窘迫综合征5例(5.6%)。肺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、肺搏动、肺水肿等。肺脏超声动态观察发现,病情的好转、加重或是新出现的肺部感染,均可通过胸膜线、A-线、肺间质综合征、肺实变、肺不张、支气管充气征等超声征象来判断。在撤呼吸机失败病例中,肺脏超声比X线更容易发现病灶。无肺脏疾病儿童肺脏超声中可见正常的胸膜线和A-线,无B-线、肺间质综合征、肺实变、支气管充气征等异常征象。结论肺脏超声对PICU肺部疾病诊断准确,尤其对病情反复及撤呼吸机的患儿更具有实用价值;超声检查便于动态监测疾病变化,提示在PICU内常规开展肺脏超声检查具有可行性及必要性。
Objective To study the characteristics and clinical value of pulmonary ultrasound in children’s intensive care unit (PICU). Methods Thirty-seven children with medical ICU and cardiothoracic ICU who visited the Children’s Hospital of Beijing Military Region General Hospital from May 1, 2015 to August 31, 2015 were enrolled in this study. Pulmonary disease was diagnosed on the basis of medical history, clinical manifestations, laboratory tests, and chest X-ray and / or CT and compared with those of pulmonary ultrasonography. Results There were 89 cases (66.7%) of pulmonary diseases in 137 cases and 48 cases (33.3%) without pulmonary diseases. 76 cases of pneumonia (85.4%) in lung disease, 8 cases of bronchiolitis (9.0%), and 5 cases (5.6%) of acute respiratory distress syndrome. The main signs of pulmonary disease A-line disappearance of the line, abnormal pleura, lung consolidation, interstitial lung syndrome, pulmonary beats, pulmonary edema and so on. Dynamic observation of pulmonary ultrasound found that the improvement of the disease, aggravating or emerging pulmonary infection, can be through the pleural line, A-line, interstitial lung syndrome, pulmonary consolidation, atelectasis, bronchial signs such as ultrasound signs To judge. In the case of unsuccessful ventilator failure, the lungs were more likely to detect lesions than the X-rays. Normal lung pleura and A-line can be seen in children with no lung disease, abnormal signs of B-line, interstitial lung syndrome, lung consolidation, bronchial inflamation sign and so on. Conclusion Pulmonary echocardiography is more accurate for the diagnosis of PICU pulmonary diseases, especially for patients with recurrent and expelled respiratory diseases. Ultrasonography is more convenient for dynamic monitoring of the disease, suggesting that it is feasible and necessary to routinely carry out pulmonary ultrasound in PICU .