重型和危重型新型冠状病毒肺炎患者床边胸部X线平片表现及其在随访中的作用  

The effect of bedside chest radiograph in the diagnosis and follow-up of severe and critical COVID-19

作　　者：陈淮[1] 邹玉坚[2] 蓝博文[3] 吴政光[4] 倪志文 黄绥丹 刘晓青[5] 宋玉全[1] 曾庆思[1] Chen Huai;Zou Yujian;Lan Bowen;Wu Zhengguang;Ni Zhiwen;Huang Suidan;Liu Xiaoqing;Song Yuquan;Zeng Qingsi(Department of Radiology,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China;Department of Radiology,Dongguan People's Hospital,Dongguan 523000,China;Department of Medical Imaging,Huizhou Municipal Central Hospital,Huizhou 516001,China;Department of Radiology,Guangdong Second Provincial General Hospital,Guangzhou 510317,China;Department of ICU,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China)

机构地区：[1]广州医科大学附属第一医院放射科,510120 [2]东莞市人民医院放射科,523000 [3]惠州市中心人民医院医学影像科,516001 [4]广东省第二人民医院放射科,广州510317 [5]广州医科大学附属第一医院重症监护室,510120

出　　处：《中华放射学杂志》2020年第6期539-543,共5页Chinese Journal of Radiology

基　　金：广东省防治新型冠状病毒科技攻关专项(2020B111105001);国家科技重大专项(2017ZX10204401)。

摘　　要：目的探讨重型及危重型新型冠状病毒肺炎(COVID-19)患者床边胸部X线平片(简称胸片)表现及其在随访中的应用价值。方法回顾性分析2020年1月23日至2月23日广东省4家COVID-19定点收治医院确诊的29例COVID-19患者的临床及床边胸片影像学资料。重型12例,危重型17例。29例患者中27例进行了床边胸片复查,复查间隔时间为1~8 d,复查次数范围为1~15次。分析所有患者床边胸片的影像学表现及随访中的影像学改变。结果29例COVID-19患者床边照片显示病灶分布范围均在3个肺野以上。胸片示实变影19例,多发斑片影23例,网格状影12例,条索状影14例,病情严重形成“白肺”者4例,伴有水平裂增厚18例。复查胸片显示病灶增多15例,表现为原病灶范围较前增大,新增病灶5例,密度增高6例,两者均有4例;病灶减少9例,表现为病灶范围缩小,密度减低,8例由斑片、实变影为条索影或细网格状影;无明显变化3例,均表现为大片状实变影。并发症有胸腔积液4例,气胸2例,纵隔及皮下气肿1例。结论床边胸片在重型及危重型COVID-19患者的诊断及随访中有很好的应用价值,可为临床医师的病情评估提供较大的帮助。Objective To explore the value of bedside chest radiograph in the diagnosis and follow-up of severe and critical COVID-19.Methods Twenty-nine patients with severe or critical COVID-19 were collected from January 23 to February 23,2020,from four COVID-19 designated hospitals in Guangdong Province.Bedside radiography was taken in all the 29 patients,ranged from 1 to 16 times for each patient.Twenty-seven patients underwent follow-up,and the number of re-examination ranged 1 to 15 times,and the interval of review is 1 to 8 days.The imaging findings of bedside chest radiography and the imaging changes on follow-up chest radiography were analyzed retrospectively.Results Twenty-nine patients were collected.The radiography showed the lesions involved all more than 3 lung fields.The films showed consolidation shadow in 19 cases,multiple patches of shadow in 23 cases,reticular pattern in 12 cases,strips shadow in 14 cases,interlobar fissure thickening in 18 cases,and"white lung"in 4 cases.The complications included pleural effusion in 4 cases,pneumothorax in 2 cases,mediastinal and subcutaneous emphysema in 1 case.The radiography showed the lesions progressed in 15 cases,with expanded involvement of the lung.The increase of lesion density was found in 6 cases,new lesions were noted in 5 cases,while both of them were found in 4 cases.Nine cases showed improvement,with reduced range and decreased density.Patchy or consolidation shadow turned to strips shadow or articular pattern shadow in 8 cases.There was no significant change in 3 cases with large consolidation shadow.Conclusions Bedside chest radiography has a good value in the follow-up of severely and critically ill patients with COVID-19,and can provide great help for clinicians to evaluate their condition.

关 键 词：新型冠状病毒肺炎 放射摄影术 

分 类 号：R563.1[医药卫生—呼吸系统] R816.4[医药卫生—内科学]