无创性肺超声指标评估儿童肺炎及支气管肺泡灌洗疗效：一项(86例)回顾性分析

Non-Invasive Lung Ultrasound Indicators for Evaluating Childhood Pneumonia and the Efficacy of Bronchoalveolar Lavage: A Retrospective Analysis of 86 Cases

摘要: 背景：肺炎已经成为儿童死亡的主要原因，能够选择一种及时准确的诊断方式已经成为热点话题。目的：比较肺超声与胸部X线在儿童肺炎诊断中的价值以及探讨二者联合应用的临床意义，同时分析肺超声在儿童肺炎治疗中的作用。方法：选取我院2023年6月至2024年6月收治的儿童肺炎患者86例，所有患者均完成了实验室检查、胸部X线检查和肺超声检查。对比肺超声检查与胸部X线检查在儿童肺炎诊断中的灵敏度、准确度、阳性预测值、假阴性，并且研究儿童肺炎患者肺超声检查中支气管充气征与支气管肺泡灌洗治疗的相关性。结果：共纳入86例患者，肺超声诊断为儿童肺炎的数量是79例，灵敏度及准确度为91.86%，胸部X线诊断为儿童肺炎的数量是69例，灵敏度及准确度为80.23%，对比二者的诊断效能，差异具有统计学意义(P < 0.05)。肺超声检查阳性患者中有11例(13.9%)支气管充气征阴性并进行了及时的支气管肺泡灌洗治疗，8例(10.1%)支气管充气征阴性但未进行及时的支气管肺泡灌洗治疗，57例(72.2%)支气管充气征阳性并未进行支气管肺泡灌洗治疗，3例(3.8%)支气管充气征阳性但进行了支气管肺泡灌洗治疗，分析结果显示，支气管充气征与支气管肺泡灌洗治疗的相关性是0.592，P值 < 0.05，差异有统计学意义，存在强相关性。结论：肺超声具有无创、无辐射、操作简单、可重复性好、便于动态监测以及安全性高等优点，且儿童具有胸壁薄的特点，可以保证肺超声成像的质量，因此可以成为儿童肺炎诊断的首要选择。同时可以减少胸部X线的使用，降低了射线对肺炎儿童的致癌风险。然而，肺超声检查也有其局限性，这时通过结合胸部X线检查，弥补肺超声检查的不足，提高肺炎儿童患者诊断的准确性，减少漏诊，提高临床的工作效率。

Abstract: Background: Pneumonia has become a leading cause of death in children, and the selection of a timely and accurate diagnostic method is a topic of significant interest. Objective: To compare the value of lung ultrasound and chest X-ray in the diagnosis of childhood pneumonia, explore the clinical significance of their combined application, and analyze the role of lung ultrasound in the treatment of childhood pneumonia. Methods: 86 children with pneumonia admitted to our hospital from June 2023 to June 2024 were selected. All patients underwent laboratory tests, chest X-ray, and lung ultrasound. The sensitivity, accuracy, positive predictive value, and negative predictive value of lung ultrasound and chest X-ray in diagnosing childhood pneumonia were compared. The correlation between the air bronchogram sign on lung ultrasound and the use of bronchoalveolar lavage (BAL) was also investigated. Results: Among the 86 patients, lung ultrasound diagnosed 79 cases of pneumonia with a sensitivity and accuracy of 91.86%. Chest X-ray diagnosed 69 cases with a sensitivity and accuracy of 80.23%. The difference in diagnostic efficacy was statistically significant (P < 0.05). Among patients with positive lung ultrasound findings, 11 (13.9%) with a negative air bronchogram sign received timely BAL, while 8 (10.1%) did not. Conversely, 3 (3.8%) patients with a positive air bronchogram sign underwent BAL, while 57 (72.2%) did not. Correlation analysis showed a strong relationship between the air bronchogram sign and the application of BAL (Cramer’s V = 0.592, P < 0.05). Conclusion: Lung ultrasound has advantages such as being non-invasive, radiation-free, simple, repeatable, convenient for dynamic monitoring and high safety, making it a primary choice for diagnosing childhood pneumonia, especially given the thin chest walls of children which allow for high-quality imaging. It reduces the use of chest X-rays and the associated cancer risk. However, lung ultrasound has limitations. Combining it with chest X-ray can compensate for its shortcomings, improve diagnostic accuracy, reduce missed diagnoses, and enhance clinical efficiency.