CAJ | 학술논문

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.前瞻性收集患者入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ARDS 31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.
목적 탐토삼유CT용적재현기술행폐좌상용적측정대예측폐좌상후ARDS발생화식별고위환자적개치. 방법 선취2010년7월-2011년6월급진흉부CT검사학진폐좌상중흉부AIS＞2분적71례환자,통과계산궤연건중건폐좌상병변범위병삼유용적재현기술측정폐좌상병변용적점쌍폐적백분비.전첨성수집환자입원자료여혈기분석결과、동맥수축압、홍세포압적、AIS、ISS화손상분포등.이Logistic회귀분석학립폐좌상후발생ARDS적독립예측인소,진일보분석예측인소적준학성화개치.관찰폐좌상용적대림상결과적영향. 결과 71례환자폐좌상용적백분비위(22.07±14.50)％(5.60％～61.00％),여입원양합지수(PaO2/FiO2)관계불대(R2=0.059).병발ARDS 31례,병발감염25례.PaO2/FiO2화폐좌상용적백분비시폐좌상후병발ARDS적독립예측인소.폐좌상용적백분비예측ARDS최가림계점위21.5％,차시특이도80.0％,민감도71.0％,양성예측치73.3％,음성예측치78.1％. 결론 이용삼유CT용적재현기술행폐좌상용량측정가정량연구폐좌상,유조우식별발생ARDS적고위환자,이편진일보치료.
Objective To investigate the value of three-dimensional CT volume rendering in predicting 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 between July 2010 and June 2011 were enrolled.Using computer-generated three-dimensional reconstruction,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 distribution,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％,sensitivity of 71.0％,positive predictive value of 73.3％,and negative predictive value of 78.1％.Conclusion 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.