三维CT容积再现技术行肺挫伤容积测定预测ARDS的价值  

Value of volume-rendering CT pulmonary contusion volume measurement in prediction of ARDS development

作　　者：王邵华[1] 周文勇[2] 赵明川[2] 张辉[2] 陈晓峰[1] 

机构地区：[1]复旦大学附属华山医院胸外科,上海200041 [2]同济大学附属上海市肺科医院胸外科

出　　处：《中华创伤杂志》2014年第3期255-259,共5页Chinese Journal of Trauma

摘　　要：目的探讨三维cT容积再现技术行肺挫伤容积测定对预测肺挫伤后ARDS发生和识别高危患者的价值。方法选取2010年7月-2011年6月急诊胸部CT检查确诊肺挫伤中胸部AIS〉2分的71例患者，通过计算机软件重建肺挫伤病变范围并三维容积再现技术测定肺挫伤病变容积占双肺的百分比。前瞻性收集患者人院资料如血气分析结果、动脉收缩压、红细胞压积、AIS、ISS和损伤分布等。以Logistic回归分析确立肺挫伤后发生ARDS的独立预测因素，进一步分析预测因素的准确性和价值。观察肺挫伤容积对临床结果的影响。结果71例患者肺挫伤容积百分比为（22．07±14．50）％（5．60％～61．00％），与入院氧合指数（PaO2／FiO2）关系不大（R2=0．059）。并发ARDS31例，并发感染25例。PaO2／FiO2和肺挫伤容积百分比是肺挫伤后并发ARDS的独立预测因素。肺挫伤容积百分比预测ARDS最佳临界点为21．5％，此时特异度80．0％，敏感度71．0％，阳性预测值73．3％，阴性预测值78．1％。结论利用三维CT容积再现技术行肺挫伤容量测定可定量研究肺挫伤，有助于识别发生ARDS的高危患者，以便进一步治疗。Objective To investigate the value of three-dimensional CT volume rendering in pre- dicting ARDS following pulmonary contusion and identifying high-risk patients. Methods Seventy-one cases of pulmonary contusion （ AIS 〉 2 points） confirmed by chest CT during an emergency admission be- tween July 2010 and June 2011 were enrolled. Using computer-generated three-dimensional reconstruc- tion, contusion volume was measured and expressed as a percentage of total lung volume. The admission data, such as blood gas analysis results, systolic arterial pressure, hematocrit, AIS, ISS, and injury dis- tribution, were prospectively collected. Independent predictive factors of ARDS following pulmonary contusion was identified using logistic regression analysis and further estimation on accuracy and value of the predictors were performed. Influence of contusion volume percentage on clinical outcomes was detected. Results Of all, mean contusion volume percentage was （22. 07 ± 14. 50 ）% （range, 5.60%- 61.00% ）, which was not strongly correlated to the admission PaO2/FiO2 ratio （R2 = 0. 059）. ARDS and infection were diagnosed in 31 cases and 25 cases respectively. PaO2/FiO2 ratio and contusion volume percentage were independent predictive factors of ARDS after pulmonary contusion. The best cut-off of contusion percentage in predicting ARDS development was 21.5% with a specificity of 80.0% , sensitivi- ty of 71.0% , positive predictive value of 73.3% , and negative predictive value of 78.1%. Conclu- sion Three-dimensional CT volume rendering technique allows quantification of pulmonary contusion and identification of patients at high risk of ARDS, to whom further treatment may be directed.

关 键 词：肺损伤 成像 三维 预测 

分 类 号：R563.8[医药卫生—呼吸系统]