急性呼吸窘迫综合征犬模型的CT表现及临床病理对照  

CT appearances of acute respiratory distress syndrome in a canine model with clinical and pathologic correlation

作　　者：陈淮[1] 李雯[2] 曾庆思[1] 刘奇[3] 刘琴[1] 周嘉璇[1] 戴望春 王寿扬[1] 黄晓燕[1] 

机构地区：[1]广州医科大学附属第一医院放射科,510120 [2]广州医科大学附属肿瘤医院核医学科,510120 [3]郑州大学第一附属医院呼吸与重症科,510120

出　　处：《中华放射学杂志》2015年第1期69-73,共5页Chinese Journal of Radiology

基　　金：广东省科技计划（20108060900090）

摘　　要：目的应用MSCT观察急性呼吸窘迫综合征（ARDS）犬模型的CT表现，并与临床、病理进行对照研究。方法健康比格犬15只，随机数字表法分为实验组（10只）及对照组（5只）。通过犬右侧股深静脉注射油酸进行造模，注射油酸后每10min为1个观察点，共观察5个时间点。最后以临床测量动脉血氧合指数（PaO2／FiO2）≤200mmHg时，确诊为ARDS成模，此时为1个观察点，通过CT扫描观察6个不同时间点犬肺部CT表现，同时记录临床数据并观察实验犬肺湿干比及病理改变。采用2个独立样本t检验对实验前及建模成功时的PaO2／FiO2及肺动脉楔压（PCWP）进行分析。结果实验组在油酸注射（92．9±8．5）rain后形成ARDS模型，实验组实验前PaOJFiO：及PCWP分别为（466．7±27．0）、（8．6±1．8）mmHg，建模成功时分别为（164．1±21．1）、（9．9±3．6）mmHg，前后差异有统计学意义（￡值分别为26．04、一1．02，P值均〈0．05）。实验组犬大体病理可见脏层胸膜张力大，呈紧绷状态，肺表面出现弥漫充血、水肿，两下肺呈朱红色类似肝组织，镜下主要表现为肺水肿、炎性细胞渗出及透明膜形成。肺湿干比重为10．4±0．7，对照组为5．3±0．8，两者差异有统计学意义（t=4．80，P〈0．05）。在ARDS成模过程中CT表现具有一定规律性，最早出现的是磨玻璃密度影，以肺野外带及肺野背部明显，偶尔会有肺实变影和代偿性的肺透亮度增高影；当犬ARDS成模时，典型的CT表现为两肺弥漫分布磨玻璃密度影（10只）、大片肺实变影（10只）、小叶间隔增厚（9只）、肺透亮度增高（7只）、胸腔积液（2只）及胸膜增厚（1只），呈不规则分布，病灶以肺的重力区明显。结论MSCT可观察ARDS的前期影像表现，可为临床诊断提供可靠的影像资料。Objective To observe CT appearances of canine models of acute respiratory distress syndrome （ADRS） with clinical and pathological correlation. Methods Fifteen healthy beagle dogs were randomly divided into the experimental group（n=10） and the control group（n=5）.CT scans of the chest were performed every ten minutes after oleic acid was injected from right thigh vein.The scans were repeated five times. When the final clinical measure of oxygenation index PaO2/FiO2〈200 mmHg, diagnosis of ARDS was made and an additional CT of the chest was performed. CT findings of dog lungs at different time points were correlated with clinical data, lung wet to dry weight ratio （W/D）and pathological changes.Two independent samples t test statistical methods were used to analyze PaO2/FiO2 and PCWP.Results ARDS model was achieved at （92.9±8.5）min after injection of oleic acid. In model group, before the injection, PaO2/FiO2 and PCWP were （466.7 ± 27.0）and （8.6±1.8）mmHg respectively, when models were successfully achieved （164.1±21.1）, （9.9±3.6） mmHg respectively.There was statistically significant difference（t=26.04, - 1.02, P〈 0.05）; Gross pathology of ARDS canine models showed visceral pleuraincreased tension, diffuse edema on the lung surface, two lungs with scarlet color mimicking liver tissue. Microscopic findings included pulmonary edema, inflammatory cell exudation and hyaline membrane formation.Mean lung wet to dry ratio of experimental group was 10.4 ± 0.7, control group was 5.3±0.8, there was statistically significant difference （t=4.80, P〈0.05）.CT findings appeared with a certain regularity in the course of ARDS formation,the ground-glass opacity appeared first, especially around and in back of the lung, followed by occasional increased pulmonary opacities and compensatory lung brightness.The typical CT findings of ARDS include： diffuse distribution of ground-glass opacity in two lungs（10）, massive pulmonary opaeities（10）,interlobular septal thickening（9

关 键 词：急性呼吸窘迫综合征 犬 体层摄影术 X线计算机 

分 类 号：R563.8[医药卫生—呼吸系统]