超聲——小兒肺炎檢查新手段
超聲領域開展的新技術——新生兒肺部超聲，越來越多的證據表明超聲肺部檢查對某些肺疾病的診斷要比X線更有優勢，無輻射，方便、快捷、使臨床醫生能更快、更準確地了解患兒的病情變化。先將一篇發表不久的英文文章簡單介紹，與大家共同學習，
Pediatric Pneumonia: Sensitivity of Lung Ultrasound vs Chest Radiography小兒肺炎：肺臟超聲檢查與胸部放射學檢查敏感性比較
Lung ultrasound was more effective in diagnosing pediatric community-acquired pneumonia (pCAP) than chest radiography, with significantly better sensitivity and similar specificity, according to the results of a meta-analysis published in Pediatric Pulmonology.
根據發表在兒科肺炎雜誌的Meta分析，肺臟超聲診斷小兒社區獲得性肺炎(pCAP)的敏感性和特異性明顯優於胸片。
Although pCAP is diagnosed clinically, radiologic confirmation is often used in complicated or uncertain cases. Chest radiography has a high false-negative rate, exposes patients to ionizing radiation, and can be difficult to obtain in areas with limited resources. Computed tomography of the chest exposes children to considerable radiation and is expensive. Provider-performed point-of-care lung ultrasound is a promising alternative: portable and radiation-free.
雖然pCAP是臨床診斷的，但在複雜或不確定的病例中，通常需要採用放射學確認。胸部X線攝影有很高的假陰性率，並且使病人暴露於電離輻射下，同時在醫療資源有限的地區無法進行放射性檢查。胸部CT掃描顯示使兒童受到相較大的輻射，而且檢查費用昂貴。肺超聲檢查是一種很有前途的選擇：便攜和無輻射。
Daniel S. Balk, MD, from the Department of Emergency Medicine, Beth Israel Deaconess Medical Center in Boston, Massachusetts, and colleagues conducted a systematic review of PubMed, EMBASE, and Web of Science and included all literature through August 2017. The investigators identified 12 studies, which included a total of 1510 patients.
來自馬薩諸塞州波士頓貝絲以色列女執事醫學中心急診部的Daniel S.Balk和他的同事對PubMed、EMBASE和Webof進行了系統的回顧研究，所有文章截至至2017年8月。研究人員分析了12項研究，總共1510名患者。
Lung ultrasound had a pooled sensitivity of 95.5% and a pooled specificity of 95.3%, and it had a positive predictive value of 99.0% and a negative predictive value of 63.1%. In contrast, chest radiography had a pooled sensitivity of 86.8% and a pooled specificity of 98.2%, whereas the positive predictive value for chest radiography was 99.6%, and the negative predictive value was 43.6%.
肺超聲的綜合敏感性為95.5%，特異性為95.3%，陽性預測值為99.0%，陰性預測值為63.1%。相比之下，胸部平片的綜合敏感性為86.8%，特異性為98.2%，胸片陽性預測值為99.6%，陰性預測值為43.6%。
The study is limited by the use of a select population with a high suspicion of pCAP, which does not reflect the general population of pediatric patients. Furthermore, there is significant heterogeneity in the positive predictive and negative predictive values found here, and thus they would only be applicable to a patient population in which there is a high clinical suspicion of pCAP, and not to pediatric patients in general.
這項研究是有限的，使用的選擇人群是高度懷疑的pCAP的患兒，這並不反映一般的兒童患者群體。此外，還存在顯著的異質性。 在這裡發現的陽性預測值和陰性預測值中，它們只適用於臨床高度懷疑pCAP的患者，而對一般兒科病人可能並不適用。
Another major limitation is the reference standard. There is considerable difficulty in differentiating bacterial pCAP, viral pneumonia, and bronchiolitis based on clinical presentation, and radiologic studies are often used to help differentiate these conditions and guide treatment. Computed tomography is usually considered the gold standard of imaging, but routine use may expose children to unnecessary radiation. Thus, chest radiography is often used to diagnose pCAP.
另一個主要限制性是參考標準。根據臨床表現和放射學特點，很難區分細菌性肺炎、病毒性肺炎和毛細支氣管炎。 放射學檢查研究經常被用來幫助區分這些疾病和指導治療。CT通常被認為是影像檢查的金標準，但是常規應用可能會使孩子們接受不必要的放射學暴露。因此，胸部平片更加常用。
Limitations aside, these results suggest the utility of lung ultrasound and demonstrate its superior sensitivity over chest radiography. However, although the evidence to support the use of lung ultrasound over chest radiography is growing, the authors noted that additional research is necessary to help differentiate bacterial from viral pneumonia.
雖然有以上局限性，研究表明肺臟超聲在敏感性上較胸部平片有明顯優勢，然而，雖然有證據支持使用肺臟超聲替代胸部X線攝影的數量正在增長，但作者同時指出，如何利用肺臟超聲來區分細菌和病毒性肺炎尚需進行更多的研究。
Reference
Balk DS, Lee C, Schafer J, et al. Lung ultrasound compared to chest X-ray for diagnosis of pediatric pneumonia: a meta-analysis [published online April 26, 2018]. Pediatr Pulmonol. doi:10.1002/ppul.24020
目前我院已逐步開展了新生兒肺部超聲檢查技術及超聲引導下肺臟佔位的活檢等介入技術，隨著超聲技術的日益成熟和經驗的逐步積累，我們相信肺臟超聲檢查將應用越來越廣泛，將為廣大泉城人民提供更好的服務，為健康保駕護航，服務。
