移动DR床旁胸片对左心室辅助装置植入术后肺淤血/肺水肿的评估价值  

The Value of Mobile DR Bedside Chest Film in the Evaluation of Pulmonary Congestion/Edema After Left Ventricular Assist Device Implantation

作　　者：李丽丽[1] 汤加 房品言 刘军波 范丽娟 LI Lili;TANG Jia;FANG Pinyan(Department of Radiology,Tianjin University Teda International Cardiovascular Hospital,Tianjin 300457,P.R.China)

机构地区：[1]天津大学泰达国际心血管病医院放射科、天津市心血管病分子调控及转化医学重点实验室,300457

出　　处：《临床放射学杂志》2024年第7期1113-1117,共5页Journal of Clinical Radiology

基　　金：国家重点研发项目(编号:2017YFC0111000)。

摘　　要：目的分析左室辅助装置(LVAD)植入术后患者床旁胸片肺淤血/肺水肿的变化及特征,探讨移动DR床旁胸片对LVAD术后肺淤血/肺水肿的评估价值。方法回顾性纳入自2019年3月开展第三代连续流LVAD植入术临床实验以来,接受手术的患者共24例。对所有患者术前、术后当天、ICU期间连续拍摄的每张床旁胸片进行图像质量评级,采用改良的肺淤血得分指数(CSI)评估系列床旁胸片的肺淤血/肺水肿变化,测量心胸比率评估心影变化,分析肺淤血/肺水肿变化与血流动力学及容量管理的关系。采用组内相关系数(ICC)分析观察者间CSI评估结果的一致性;采用配对t检验比较患者术前与术后ICU最后一天CSI的差异性。结果共纳入床旁胸片526张,图像质量均为优。18例出现肺淤血/肺水肿先加重后减轻的趋势,6例肺淤血/肺水肿反复加重;肺淤血/肺水肿最重出现在术后1周内;ICU最后一天肺淤血/肺水肿均较术前减轻(CSI:1.11±0.64 vs 0.53±0.60,t=8.86,P<0.001);观察者间CSI评估的一致性好(术前ICC=0.995,P<0.001;术后ICU最后一天ICC=0.976,P<0.001)。24例心影大小均出现先增大后减小的趋势,心影最大出现在术后1周内,至ICU最后一天,7例心影较术前增大,2例无明显变化,其余均较术前减小。结论移动DR床旁胸片可以快速、有效地评估LVAD植入术后患者肺淤血/肺水肿及心影变化,对指导ICU期间容量管理具有重要价值。Objective To investigate the value of mobile DR bedside chest film in evaluating pulmonary congestion/edema after left ventricular assist device(LVAD)implantation.Methods 24 patients who underwent LVAD implantation were included,since the clinical trial of the third generation continuous flow LVAD implantation in our hospital in March 2019.The image quality of each bedside chest film taken continuously in all patients preoperatively,the day after operation and during ICU was graded.The changes of pulmonary congestion/edema in series of bedside chest films were evaluated by the modified pulmonary congestion score index(CSI).The changes of cardiac shadow were evaluated by measuring cardiothoracic ratio,and the relationship between changes of pulmonary congestion/edema and hemodynamics and volume management was analyzed.Interclass correlation coefficient(ICC)was used to analyze the consistency of CSI evaluation results among observers,and paired t-test was used to compare the difference of CSI between before operation and the last day of postoperative ICU.Results A total of 526 bedside chest films were included,and the image quality was all excellent.Pulmonary congestion/edema aggravated first and then decreased in 18 cases,repeated aggravation in 6 cases,and the worst pulmonary congestion/edema was concentrated within 1 week after operation.The pulmonary congestion/edema on the last day of ICU was less than that before operation(CSI:1.11±0.64 vs 0.53±0.60,t=8.86,P<0.01).The consistency of CSI evaluation among observers was good(ICC=0.995 before operation,P<0.01;ICC=0.976 on the last day of ICU,P<0.01).The size of cardiac shadow increased at first and then decreased in all 24 cases.The largest cardiac shadow appeared within 1 week after operation,and by the last day of ICU,7 cases had an increase in cardiac shadow compared with preoperative,2 cases had no significant change,and the rest had a decrease.Conclusion Mobile DR bedside chest radiographs can quickly and effectively evaluate the changes of pulmonary conge

关 键 词：左心室辅助装置 床旁胸片 肺淤血/肺水肿 

分 类 号：R654.2[医药卫生—外科学] R816.2[医药卫生—临床医学]