The Application Value Of Lung Ultrasound Score In The Treatment Of Neonatal Respiratory Distress Syndrome With Mechanical Ventilation

Objective:To explore the application value of lung ultrasound score in the treatment of neonatal respiratory distress syndrome(NRDS)with mechanical ventilation,and to provide a basis for clinical treatment.Methods:(1)Study on the predictive value of lung ultrasound score in the timing of mechanical ventilation in children with NRDS.Select 580 children diagnosed with NRDS who were admitted to the Department of Neonatology,Guangdong Second People’s Hospital from April 1,2018 to May 30,2019 as the research subjects.Complete lung ultrasound and blood gas analysis within 2 hours of the first chest radiograph,and adopt different auxiliary ventilation modes according to the severity of the disease.Spearman correlation was used to analyze the correlation between lung ultrasound score and X-ray classification,auxiliary ventilation mode classification,and blood gas analysis;the ROC curve was drawn to pre-evaluate the predictive efficacy of lung ultrasound score in mechanical ventilation of children with NRDS.(2)Lung ultrasound scores are used to study the predictive value of NRDS children with mechanical ventilation.Select 382 children with NRDS who were admitted to the Department of Neonatology,Guangdong Second People’s Hospital from April 1,2018 to August 30,2020,who were treated with mechanical ventilation.Divide them into a successful weaning group(208 cases)and a failed weaning group(104 cases).Complete lung ultrasound,heart color Doppler ultrasound,chest X-ray,blood gas analysis and other examinations 2 hours before weaning.By comparing the clinical data of the two groups,the single-factor and multi-factor logistic regression analysis was performed to determine the risk factors that affect the failure of weaning;then based on the risk factors,a predictive model for the failure of NRDS mechanical ventilation was established;evaluate whether the predictive ability of lung ultrasound score for weaning failure is statistically different from the joint prediction model.Results:Part 1:The lung ultrasound scorewere statistically different from X-ray classification,assisted ventilation mode classification and oxygenation index(P<0.05).Through spearman correlation analysis,it is suggested that lung ultrasound scores are positively correlated with X-ray classification,mode classification of auxiliary ventilation,and oxygenation index of children with NRDS.The AUC value of lung ultrasound score in NRDS treatment is 0.867,the predictive sensitivity of mechanical ventilation treatment is 0.871,and the specificity is 0.637.Part 2:Length,birth weight,partial pressure of arterial carbon dioxideand lung ultrasound score are risk factors for weaning failure.Based on the risk factors,a comprehensive prediction of the weaning failure was made.The area under the curve(AUC)of the combined model is 0.880(95%CI:0.839-0.914),the sensitivity is 85.85%(95%CI:77.7-91.9),and the specificity is 77.88%(95%CI:71.6-83.3).The predictive ability of the combined model and lung ultrasound was not statistically different(Z=0.427,P=0.669).The area under the curve of LUS is 0.867,the sensitivity is 84.91%,and the specificity is 80.77%.Conclusions:(1)Lung ultrasound score can be used to predict the timing of mechanical ventilation in children with NRDS;there is a certain correlation among lung ultrasound score,X-ray classification and oxygenation index.(2)The lung ultrasound score can be used to predict the weaning of children with NRDS treated by mechanical ventilation,and is related to the success rate of weaning;the sensitivity of weaning prediction is high.(3)Lung ultrasound can be a convenient,safe and effective imaging guidance basis for NRDS mechanical ventilation application and withdrawal in clinical practice.