肺脏超声对儿童肺炎的诊断价值

张雪君 钟永青 马显送

[摘要]目的 探讨肺脏超声对儿童肺炎的诊断价值。方法 选取 2015年 9 月～2017 年 9月在我院住院，经病史、临床表现和影像学检查确诊为肺炎的50例患儿作为研究对象，患儿均进行肺脏超声和X线检查。观察胸膜线、A- 线、B-线、肺实变、动态支气管充气征、“白肺”、间质综合征、彗星尾征、肺滑与肺搏动、双肺点、胸腔积液征等异常表现；根据肺炎的不同发展时期，肺部的超声表现形式多样，包括肺实变、胸膜炎性改变以及胸腔积液等，对X线与肺部超声影像学结果进行比较，并对两组的准确度、特异度和敏感度情况进行比较。结果 超声科共收治56例疑似肺炎患儿，50例确诊，全部行肺部X线和超声检查。肺部超声真阳性48例，假阳性2例，假阴性2例，真阴性4例；胸部X线检查真阳性40例，假阳性5例，假阴性10例，真阴性1例；肺部超声影像学的准确度、特异度、敏感度明显高于X线检查，差异均有统计学意义（P<0.05）。结论 肺脏超声对儿童肺炎具有重要的诊断价值，可以作为X线检查的有效补充。

[关键词] 肺炎；儿童，超声检查；X线

[中图分类号] R563.1 [文献标识码] A [文章编号] 1674-4721（2018）7（c）-0085-03

[Abstract] Objective To investigate the diagnostic value of lung ultrasound in children with pneumonia. Methods A total of 50 children with pneumonia diagnosed by medical history， clinical manifestations， and imaging examinations were selected as the subjects from September 2015 to September 2017. All children underwent lung ultrasound and X-ray examination. The pleural line， A-line， B-line， lung consolidation， dynamic bronchial airway sign， "white lung"， interstitial syndrome， comet tail sign， lung slide and lung pulse， bilateral lung points， thoracic cavity liquid symptoms and other abnormal performance were observed. According to the different stages of development of pneumonia， the pulmonary ultrasound manifestations were various， including lung consolidation， pleural inflammatory changes， and pleural effusions， X-ray and lung ultrasound imaging results compared， and the accuracy， specificity， and sensitivity of the two groups were compared. Results In the ultrasound department， 56 patients with suspected pneumonia were treated and 50 were diagnosed. All the patients underwent X-ray and ultrasonography. There were 48 cases of true positive pulmonary ultrasounds， 2 cases of false positives， 2 cases of false negatives， and 4 cases of true negatives. 40 cases of true positive chest X-rays， 5 cases of false positives， 10 cases of false negatives， and 1 case of true negative. The accuracy， specificity， and sensitivity of pulmonary ultrasound imaging were significantly higher than those of X-ray， the differeces were statistically significiant （P<0.05）. Conclusion Lung ultrasound has important diagnostic value for children with pneumonia and can be used as an effective supplement for X-ray examination.

[Key words] Pneumonia； Children； Ultrasonography； X-ray

肺炎是發展中国家和地区儿童死亡最重要的病因。准确和及时地诊断对儿童肺炎，特别是重症肺炎的治疗和预后来说极其重要[1]。长期以来，肺炎的诊断和鉴别诊断主要依赖传统胸部X-线与CT检查，但这种检查存在明显的局限性。肺脏超声可以克服或避免上述X线与CT检查的缺点，具有无辐射、简便、可床边开展、可动态观察等诸多优点。由于肺部超声具有极高的准确性与可靠性，在某些先进的新生儿重症监护单位已经替代胸部X线成为新生儿肺部疾病的一线诊断手段且对肺脏疾病的诊断具有更高的准确性和可靠性[2-3]。……