CAJ | 학술논문

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10 min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)≤200 mmHg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)min后形成ARDS模型,实验组实验前PaO2/FiO2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(t值分别为26.04、-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.
목적 응용MSCT관찰급성호흡군박종합정(ARDS)견모형적CT표현,병여림상、병리진행대조연구.방법 건강비격견15지,수궤수자표법분위실험조(10지)급대조조(5지).통과견우측고심정맥주사유산진행조모,주사유산후매10 min위1개관찰점,공관찰5개시간점.최후이림상측량동맥혈양합지수(PaO2/FiO2)≤200 mmHg시,학진위ARDS성모,차시위1개관찰점,통과CT소묘관찰6개불동시간점견폐부CT표현,동시기록림상수거병관찰실험견폐습간비급병리개변.채용2개독립양본t검험대실험전급건모성공시적PaO2/FiO2급폐동맥설압(PCWP)진행분석.결과 실험조재유산주사(92.9±8.5)min후형성ARDS모형,실험조실험전PaO2/FiO2급PCWP분별위(466.7±27.0)、(8.6±1.8)mmHg,건모성공시분별위(164.1±21.1)、(9.9±3.6)mmHg,전후차이유통계학의의(t치분별위26.04、-1.02,P치균＜0.05).실험조견대체병리가견장층흉막장력대,정긴붕상태,폐표면출현미만충혈、수종,량하폐정주홍색유사간조직,경하주요표현위폐수종、염성세포삼출급투명막형성.폐습간비중위10.4±0.7,대조조위5.3±0.8,량자차이유통계학의의(t=4.80,P＜0.05).재ARDS성모과정중CT표현구유일정규률성,최조출현적시마파리밀도영,이폐야외대급폐야배부명현,우이회유폐실변영화대상성적폐투량도증고영;당견ARDS성모시,전형적CT표현위량폐미만분포마파리밀도영(10지)、대편폐실변영(10지)、소협간격증후(9지)、폐투량도증고(7지)、흉강적액(2지)급흉막증후(1지),정불규칙분포,병조이폐적중력구명현.결론 MSCT가관찰ARDS적전기영상표현,가위림상진단제공가고적영상자료.
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 PaO22/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 opacities(10),interlobular septal thickening(9),increasedlung brightness (7),small amount of pleural effusion(2) and pleural thickening (1).Lesion distribution appeared to be random,more obvious in lung gravity zone.Conclusion CT imaging findings of ARDS can provide reliable information for early diagnosis of ARDS.