【摘要】 目的：探讨肺部超声评分（LUS）动态改变在小儿重症肺炎病情评估及呼吸治疗指导中的应用价值。方法：回顾性分析2021年4月-2022年4月福建省儿童医院收治的重症肺炎患者116例的临床资料，依据急性生理功能与慢性健康状况评分系统Ⅱ（APACHEⅡ）分为非危重症组（64例）和危重症组（52例），随访2个月，对比两组患儿临床肺部感染评分（CPIS）、氧合指数（OI）及LUS的差异；再以患儿起始呼吸治疗结局分为失败组与成功组，分析LUS动态变化对小儿重症肺炎患者呼吸支持策略的预测价值。结果：危重组患儿LUS、CPIS评分及机械通气时间均显著高于非危重组（P<0.05）,OI显著低于非危重组（P<0.05）。52例危重症肺炎患儿起始呼吸治疗成功36例，失败16例；两组第1、2次LUS评分比较差异无统计学意义（P>0.05），成功组第3～5次评分均显著低于失败组（P<0.05）。Pearson相关性分析显示，LUS评分与OI指标呈负相关（r=-0.751,P=0.000），与CPIS评分及机械通气时间呈正相关（r=0.562、0.370,P=0.003、0.038）。LUS评分截断值19.15分，预测危重症肺炎患儿需要升级呼吸支持治疗的AUC为0.865,Youden指数为0.611，敏感度为83.3%，特异度为77.8%。结论：LUS评分能够作为小儿重症肺炎病情评估指标，并且能够帮助医生治疗呼吸治疗策略，改善患者的预后。更多还原

【Abstract】 Objective: To explore the application value of dynamic changes of lung ultrasound score(LUS) in the assessment of severe pneumonia in children and the guidance of respiratory therapy. Method: The clinical data of 116 patients with severe pneumonia admitted Fujian Children’s Hospital from April 2021 to April 2022 were retrospectively analyzed, and they were divided into noncritically ill group(64 cases) and critically ill group(52 cases) according to acute physiological and chronic health score system Ⅱ(APACHE Ⅱ), they were followed up for 2 months, and the differences in clinical pulmonary infection score(CPIS), oxygenation index(OI) and LUS were compared between the two groups; the children were divided into failure group and success group based on the outcome of initial respiratory treatment, the predictive value of LUS dynamic changes on respiratory support strategies in children with severe pneumonia was analyzed. Result: The LUS score, CPIS score and mechanical ventilation time of the children in the critically ill group were significantly higher than those in the non-critically ill group(P<0.05), the OI was significantly lower than that in the non-critically ill group(P<0.05). Initial respiratory therapy was successful in 36 cases and failed in 16 cases of 52 children with severe pneumonia; there were no significant differences in the first and second LUS scores between the two groups(P>0.05), the 3rd to 5th scores of the successful group were significantly lower than those of the failed group(P<0.05). Pearson correlation analysis showed that LUS score was negatively correlated with OI index(r=-0.751, P=0.000), and positively correlated with CPIS score and mechanical ventilation duration(r=0.562,0.370; P=0.003, 0.038). The cut-off value of LUS score was 19.15 points, and the AUC, Youden index, sensitivity, and specificity were 0.865, 0.611, 83.3%, and 77.8%, respectively, in predicting the need for upgraded respiratory support in children with severe pneumonia.Conclusion: The LUS score can be used as an evaluation index for severe pneumonia in children, and it can help doctors treat respiratory treatment strategies and improve the prognosis of patients.更多还原