院内获得性肺炎的影像学评价

Imaging Evaluation of Hospital Acquired Pneumonia

探讨院内获得性肺炎的影像学特点。对2009年我院确诊为院内获得性肺炎的56例病人的临床及影像资料进行回顾性分析。56例院内获得性肺炎病人中,原发病分别为血液病14(25%)例、外科系统疾病14(25%)例、恶性肿瘤8(14.3%)例、慢性肝胆疾病8(14.3%)例、多脏器衰竭5(8.9%)例、慢性呼吸系统疾病3(5.4%)例及其他4(7.1%)例。病原菌有多重细菌混合感染33(58.9%)例、铜绿假单胞菌3(5.4%)例、粪肠球菌2(3.6%)例、金黄色葡萄球菌1(1.8%)例、甲型溶血性链球菌2(3.6%)例、流感病毒1(1.8%)例、真菌8(14.3%)例及未明病原菌6(10.7%)例。影像学表现为支气管肺炎样表现36(64.3%)例、大叶实变4(7.1%)例、结节9(16.1%)例、间质病变合并实变3(5.4%)例、肺水肿4(7.1%)例、双肺弥漫实变7(12.5%)例、空洞2(3.6%)例及胸腔积液39(69.6%)例。支气管肺炎样表现合并胸腔积液为院内获得性肺炎的主要影像学表现,还可有结节、间质病变、肺水肿及双肺弥漫实变等征象。胸片是其最基本的影像学手段,CT对于胸片诊断不明确和微小病变的发现有意义。

To discuss the radiographic features of hospital acquired pneumonia（HAP）,clinical and imaging data of 56 patients who were diagnosed as HAP in our hospital in 2009 were analyzed retrospectively.Of all these patients, the primary diseases were blood disease in 14 （25%）cases, surgical diseases in 14 （25%） case, malignant tumors in 8 （14.3%） cases, chronic liver and gallbladder diseases in 8 （14.3%） cases, multiple organ failure in 5 （8.9%） cases, chronic respiratory disease in 3 （5.4%） cases and other in 4 （7.1%） cases. Mixed infections with multiple bacterial pathogens were in 33（58.9%） cases, Pseudomonas aeruginosa diseases in 3（5.4%）case,enterococcus faecalis in 2（3.6%） cases,staphylococcus aureus in 1（1.8%） cases, alpha hemolytic streptococcus in 2（3.6%） patients, influenza virus in 1（1.8%） cases, fungus in 8（14.6%） cases and no detectable bacteria in 6（10.7%） cases. Imaging features were shown as bronchial pneumonia in 36（64.3%） cases,lose consolidation in 4（7.1%）cases, nodular in 9（16.1%） cases, interstitial disease associated with infection in 3（5.4%） cases, pulmonary edema in 4 （7.1%） cases, diffuse consolidation in 7 （12.5%） cases,cavity in 2（3.6%） and pleural effusion in 39（69.6%） cases. Bronchial pneumonia complicated with pleural effusion is the main imaging finding,and may accompany with nodules, interstitial disease, pulmonary edema and diffuse consolidation and other signs. Chest film is the most basic means of imaging methods.CT is used for diagnosis of uncertain cases.