新生儿肺透明膜病并发支气管肺发育不良的X线诊断  

X-ray manifestation of neonatal hyaline membrane disease complicated by bronchopulmonary dysplasia

作　　者：王桂忠[1] 曾芳[2] 王经龙[1] 段捷[1] 

机构地区：[1]江西省吉安市妇幼保健院放射科,江西吉安343000 [2]江西省吉安市妇幼保健院NICU科,江西吉安343000

出　　处：《中国现代医生》2016年第8期117-120,共4页China Modern Doctor

摘　　要：目的探讨新生儿肺透明膜病（hyaline menbrane disease,HMD）并发支气管肺发育不良（bronchopulmonary dysplasia,BPD）的X线表现,以提高对该病并发症的早期诊断能力。方法搜集HMD并发BPD患者68例。全部病例均摄胸片,对所有病例的胸部影像资料进行回顾性分析。结果本组HMD治疗后并发BPD患者68例。HMD在治疗过程中动态观察病程如下：入院时胸片表现为HMDⅠ级4例,Ⅱ级12例,Ⅲ级32例,Ⅳ级20例。使用肺泡表面活性物质（PS）及机械通气后1～2 d复查胸片,42例X线表现为两肺充气度好转,颗粒及小片状影减少,支气管充气征消失。26例X线表现为两肺充气度稍差,两肺颗粒影及支气管充气征减少;在机械通气或吸氧治疗后2～4周连续复查胸片,68例HMD并发BPD的患儿胸片均有在HMD吸收好转过程中,2～3周开始出现两肺透亮度减低,呈磨玻璃影,伴两肺野小片状及云絮状影,而且该影像表现吸收相对较慢,持续时间1周以上。3～4周以后均出现不同程度的网格状及囊泡状阴影改变,其中49例表现为两肺出现条索状影,夹杂大小不等小片状、小囊状透亮影;19例表现为两肺广泛纤维化,呈网状及蜂窝状影伴肺气肿。结论 HMD并发BPD其胸部X线影像虽无特征性,但连续复查胸片往往可以做出早期诊断。Objective To investigate the X-ray manifestation of neonatal hyaline membrane disease（HMD） complicated by bronchopulmonary dysplasia（BPD）,in order to improve the early diagnostic capability for this complication. Methods A total of 68 cases with HMD complicated by BPD were selected. Chest radiography was performed for all the cases,and the chest radiographic data of all the cases were retrospectively analyzed. Results The following dynamic changes were observed during the treatment of 68 HMD cases complicated by BPD： For the grade of HMD revealed by chest Xray on admission, there were 4 cases of grade Ⅰ, 12 cases of grade Ⅱ, 32 cases of grade Ⅲ and 20 cases of grade Ⅳ.Chest radiography reexamination was performed for all the patients 1 to 2 days after application of pulmonary surfactant（PS）and mechanical ventilation. For the X-ray manifestation, 42 cases showed improved inflation in both lungs, reduced granular and small patchy shadows, and disappeared air bronchogram; 26 cases showed poorer inflation in both lungs, as well as reduced granular shadows and air bronchogram in both lungs. Consecutive chest radiography reexamination was performed for all the patients 2 to 4 weeks after mechanical ventilation and oxygen therapy. For the X-ray manifestation of HMD complicated by BPD during the absorption and improvement of HMD, all the 68 cases showed reduced transparency in both lungs, with ground-grass opacity complicated by small patchy and cloudy shadows 2 to 3weeks later. Such manifestation lasted for more than one week as a result of slow absorption. Then, 3 to 4 weeks later,varying degrees of reticular and vesicular shadows were present, with 49 cases showing funicular shadows in both lungs,mixed up with small patchy and cystic lucent shadows of different sizes, and 19 cases showing widely distributed fibrosis in both lungs complicated by emphysema, with reticular and honeycomb shadows. Conclusion Although the chest X-ray manifestation of HMD complicated by BPD has no specific characteristi

关 键 词：肺透明膜病 支气管肺发育不良 X线摄影 新生儿 

分 类 号：R722[医药卫生—儿科]