SARS的胸部X线平片分析  

The analysis of X-ray chest plain film in patients with SARS

作　　者：姚新宇[1] 李坤成[1] 杜祥颖[1] 尹建国[1] 卢洁[1] 彭靖[1] 

机构地区：[1]首都医科大学宣武医院医学影像学部,北京100053

出　　处：《实用医学影像杂志》2005年第1期9-12,共4页Journal of Practical Medical Imaging

摘　　要：目的研究SARS患者X线胸部平片的征象及其演变规律,以指导治疗及评价预后。方法应用移动式X光机和计算机摄影(computedradiography,CR)进行床旁投照,高分辨率肖像型专业显示器进行图像显示和分析。搜集70例资料完整的SARS患者,分析其X线胸部平片的征象、演变规律,以及与临床的相关性。采用SPSSWIN(10.0版)软件进行资料的统计学分析。结果SARS患者的X线胸部平片检查显示病变以双肺较高或高密度的片状阴影为主,可伴有肺间质改变,主要分布于双肺中下肺野。病变大小均超过全肺面积的30%,以30%～49%之间者居多(31例),病变范围越大,持续时间越长,患者的病死率越高。上述重症表现可持续多天,部分(19例)伴有弥漫性肺间质改变。肺间质改变评为3分者,其病死率显著高于评分不足3分者(p<0.01)和呈轻度弥漫性间质改变评为2分者(p<0.05)。有重度弥漫性肺间质改变,肺浸润阴影大于全肺面积50%是引起SARS患者病死的重要危险因素。SARS的合并症主要包括细菌性或霉菌性感染,成人呼吸窘迫综合症,气胸、纵隔气肿和皮下气肿等。康复期肺内病变范围缩小,伴随的肺内间质改变减轻,甚至消失。结论SARS具有一定的影像特征,X线胸部平片可用于SARS的预后评估及疗效判断。Objective To study the signs of X-ray chest plain film and to predict the development regularity of patients with SARS, so as guiding treatment and evaluating the prognosis. Methods The mobile X-ray system and computer radiography were used to take the bedside radiogram, and the high resolution portrait special monitor were used for display and analysis of the images. Seventy patients with SARS as comprehensive data were collected to analyses the chest X-ray findings, the regularity of development of the foci, and the correlation between radiological findings and clinical manifestations.SPSS WIN(10.0 )was used for statistic analysis of the data. Results The chest X-ray film of SARS cases showed abnormal signs as follow: bilateral patch lesions in higher or high density, which could accompanied with pulmonary interstitial changes, and mainly located in bilateral middle and low fields. The size of foci were over 30 %of the area of all pulmonary field, of them, majority (31 cases) was 30 %～49 %.The bigger size of the foci and persisted longer, the higher mortality. Above-mentioned findings of SARS could be appearance for several days, and accompany diffuse pulmonary interstitial changes in some patients (19).The mortality of patients their pulmonary interstitial changes were evaluated as point 3, was marked higher than those their pulmonary interstitial changes were evaluated as < point 3 or 2 (p< 0.05).The severe pulmonary interstitial changes, and the size of foci were over 50 %of the area of lungs were important risk factor of leading to death of SARS patients. The complication of SARS included mainly bacterial infection and/or fungal infection, ARDS, pneumothorax, pneumomediastinum and subcutaneous emphysema. The size of foci was decreased and the pulmonary interstitial changes accompanied were alleviated even disappear during recovery stage.Conclusions X-ray findings of SARS are particular characteristic. Chest X-ray plain film can be used in evaluation of prognosis and therapeutic profits in SARS cases.

关 键 词：SARS X线胸部平片 合并症 预后 

分 类 号：R511.9[医药卫生—内科学] R816.4[医药卫生—临床医学]