庞杰锋 　叶健华 刘贤清

【摘要】 目的：比較彩色多普勒超声（CDUS）与胸部DR在小儿支气管肺炎诊断和疗效评估中的应用价值。方法：以2017年9月-2018年9月在笔者所在医院就诊的疑似小儿支气管肺炎的50例患儿为研究对象，所有患儿入院时均接受CDUS、胸部DR及胸部CT检查，以胸部CT作为支气管肺炎诊断的金标准。对于确诊为支气管肺炎的患儿进行经验性抗生素治疗，1周后接受超声、胸部DR及胸部CT检查，评估临床治疗是否有效;以CT结果作为疗效评价的金标准，比较两种检查方法的灵敏度、特异度并计算Kappa值。结果：CDUS诊断支气管肺炎的灵敏度为95.5%，特异度为66.7%;胸部DR诊断支气管肺炎的灵敏度为97.7%，特异度为50.0%;CDUS和胸部DR诊断支气管肺炎的观察一致性为92.0%，机遇一致性为81.9%（κ=0.56，P<0.05）。CDUS评估治疗效果的灵敏度为97.1%，特异度为66.7%;胸部DR评估治疗效果的灵敏度为94.6%，特异度为71.4%;CDUS和胸部DR评估治疗效果的观察一致性为84.0%，机遇一致性为56.7%（κ=0.79，P<0.05）。结论：CDUS与胸部DR在小儿支气管肺炎诊断和疗效评估中的敏感度和特异度无显著差异，具有较高的一致性，由于超声具有无辐射、花费少、可动态床旁观察等优点，更适合作为小儿支气管肺炎诊断和疗效评估的辅助检查。

【关键词】 彩色多普勒超声 胸部DR 小儿支气管肺炎

doi：10.14033/j.cnki.cfmr.2019.28.031 文献标识码 B 文章编号 1674-6805（2019）28-00-03

Comparison of Color Doppler Ultrasound and Chest DR in Diagnosis and Therapeutic Evaluation of Bronchopneumonia in Children/PANG Jiefeng， YE Jianhua， LIU Xianqing. //Chinese and Foreign Medical Research， 2019， 17（28）： -77

[Abstract] Objective： To compare the value of color Doppler ultrasound （CDUS） and chest DR in the diagnosis and therapeuticevaluation of Bronchopneumonia in children. Method： A total of 50 children with suspected pediatric bronchopneumonia who were treated in our hospital from September 2017 to September 2018 were enrolled. All children underwent CDUS， chest DR and chest CT examinations. Chest CT was the gold standard for the diagnosis of bronchopneumonia. For patients diagnosed with bronchopneumonia， empirical antibiotic treatment was performed. One week later， ultrasound， chest DR and chest CT were used to evaluate whether clinical treatment was effective. CT results were used as the gold standard for evaluation. The sensitivity and specificity of the two methods were compared. And calculate the Kappa value. Result： The sensitivity of CDUS in the diagnosis of bronchial pneumonia was 95.5%， the specificity was 66.7%. The sensitivity of chest DR diagnosis of bronchopneumonia was 97.7%， the specificity was 50.0%. The observational consistency in CDUS and chest DR diagnosis of bronchopneumonia was 92.0%， the opportunity consistency was 81.9% （κ=0.56， P<0.05）. The sensitivity of CDUS in evaluating the therapeutic effect was 97.1%， the specificity was 66.7%. The sensitivity of chest DR evaluation was 94.6%， and the specificity was 71.4%. The observational consistency in CDUS and chest DR therapeuticevaluation was 84.0%， the opportunity consistency was 56.7% （κ=0.79， P<0.05）. Conclusion： CDUS and chest DR have no significant difference in sensitivity and specificity in the diagnosis and evaluation of bronchopneumonia in children， and have high consistency. Ultrasound has the advantages of no radiation， low cost and dynamic bedside observation， so it is more suitable for assistant examination in diagnosis and evaluation of curative effect of bronchopneumonia in children.

[Key words] Color Doppler ultrasound Chest DR Bronchopneumonia in children

First-authors address： Dalingshan Hospital of Dongguan， Dongguan 523820， China

支气管肺炎是指主要累及气道和周围的间质组织的下呼吸道感染，有时见于化脓性链球菌及金黄色葡萄球菌肺炎。据统计，在全球0～5岁的低龄儿童中，每年约有1.56亿人患病，其中约2 000万人病情较为严重，需住院治疗[1]。2015年全世界因肺炎导致死亡的儿童数为800 000例（每100 000人发生31.1例），仅次于新生儿/早产并发症[2]。小儿支气管肺炎的早诊断、早治疗对于改善患儿预后，降低死亡率至关重要。通常对于具有典型症状的支气管肺炎患儿，可以通过查体、病史及临床表现初诊，再通过其他方式确诊或者直接进行经验性治疗，不必将影像学检查作为常规检查手段。对于临床表现不典型的患儿，则需进行影像学检查以明确诊断[3]。……