多层螺旋CT对严重多发伤患者低血容量性休克的预测价值  

Values of multi-slice spiral computed tomography on predicting hypovolemic shock in patients with severe multiple trauma

作　　者：李阳[1] 张连阳[1] 王毅[2] 张伟国[2] 

机构地区：[1]第三军医大学大坪医院野战外科研究所,全军战创伤中心,创伤,烧伤与复合伤国家重点实验室,重庆400042 [2]第三军医大学大坪医院放射科

出　　处：《解放军医学杂志》2013年第1期48-53,共6页Medical Journal of Chinese People's Liberation Army

基　　金：国家科技支撑计划(2012BAI11B01);全军"十二五"重点课题(DWS12J033)~~

摘　　要：目的探讨多层螺旋CT(MSCT)对严重多发伤患者低血容量性休克的预测价值。方法回顾分析2008年1月-2011年12月收治的63例严重多发伤患者的临床及CT资料,根据增强CT检查后24h内是否发生休克,将患者分为休克组(34例)和稳定组(29例)。统计两组患者入院时血压、心率、休克指数、损伤严重程度评分(ISS)等,并测量下腔静脉横径(T)与前后径(AP)、腹主动脉直径(D)、腹部脏器增强扫描早期及延迟期CT值,对两组间存在统计学差异的指标进行受试者工作特征(ROC)曲线和logistic回归分析。结果休克组休克指数、ISS评分及4个腹部平面的下腔静脉塌陷指数(T/AP)均显著大于稳定组(P<0.05,P<0.01)。休克组增强早期脾CT值(93±16HU)显著低于稳定组(112±24HU),肾上腺CT值(153±35HU)显著高于稳定组(131±24HU),休克组延迟期肾脏髓质CT值(193±57HU)显著低于稳定组(228±53HU),差异均有统计学意义(P<0.05,P<0.01)。休克指数,ISS评分,下腔静脉塌陷指数(T/AP),增强早期脾脏CT值、肾上腺CT值及延迟期肾髓质CT值的ROC曲线最佳诊断切点分别为1.19、19.5、3.02、115HU、150HU、184HU。Logistic回归分析显示,ISS评分、下腔静脉塌陷指数(T/AP)、增强早期肾上腺CT值、增强延迟期肾髓质CT值对低血容量性休克的发生具有预测价值(P<0.05)。结论下腔静脉塌陷、增强扫描早期肾上腺增强强化、延迟期肾脏髓质强化减弱等CT征象对预测严重多发伤患者低血容量性休克的发生具有一定价值。Objective To investigate the value of multi-slice spiral computed tomography（MSCT） on predicting hypovolemic shock in patients with severe multiple trauma.Methods The clinical and MSCT data of 63 patients with severe multiple trauma admitted to the Trauma Center from Jan.2008 to Dec.2011 were retrospectively reviewed.According to the occurrence of hypovolemic shock in 24 hours after CT scan,the patients were divided into shock group（n=34） and stable group（n=29）.Blood pressure,heart rate,shock index and injury severity score（ISS） on admission were collected and analyzed.Transverse（T） and anteroposterior（AP） diameter of inferior vena cava（IVC）,diameter of abdominal aorta,CT values of enhanced CT of abdominal organs both in early and late phase were measured.The differences of aforementioned parameters between the two groups were compared by Student＇s t test.The values of above indexes showing significant difference between the two groups on predicting hypovolemic shock were analyzed by using receiver operating characteristic（ROC） curve and logistic regression analysis.Results The shock index,ISS and collapsibility index（T/AP） of IVC in 4 abdominal levels were significantly greater in shock group than in stable group（P〈0.05）.In early phase of enhanced CT,the mean CT value of spleen was significantly lower in shock group（93±16HU） than in stable group（112±24HU,P0.01）,while the mean CT value of adrenal gland was higher in shock group（153±35HU） than in stable group（131±24HU,P0.01）.In delayed phase,the mean CT value of renal medulla was significantly lower in shock group（193±57HU） than in stable group（228±53HU,P〈0.05）.The diagnostic cutoff value of ROC curve of shock index,ISS,collapsibility index（T/AP） of IVC,CT value of spleen and adrenal gland in early phase,CT value of renal medulla in delayed phase were 1.19,19.5,3.02,115HU,150HU and 184HU,respectively.Logistic regression analysis showed that ISS,T/AP of IVC,CT value of adrenal gland in

关 键 词：体层摄影术 螺旋计算机 创伤和损伤 休克 失血性 

分 类 号：R605.971[医药卫生—急诊医学] R814.42[医药卫生—外科学]