增强螺旋CT腹部血管低灌注征象在严重创伤患者低血容量性休克评估中的作用

Value of hypo-perfusion signs of abdominal vessels on enhanced spiral CT in evaluation of hypov- olemic shock in severe traumatic patients

目的探讨增强螺旋cT腹部血管低灌注征象对严重创伤患者低血容量性休克评估的意义。方法回顾性分析2008年1月-2011年12月收治的63例严重创伤患者的临床及螺旋cT影像学资料，根据螺旋cT检查后24h内是否发生休克，将患者分为休克组（34例）和稳定组（29例）。分析比较两组患者入院时血压、心率、ISS评分、血pH值、血乳酸（Lac）及碱剩余（BE）等指标，并测量增强螺旋CT影像中主动脉、下腔静脉、肠系膜上动、静脉等腹部大血管的直径及增强早期和延迟期CT值。结果休克组ISS评分及Lae水平显著高于稳定组，而BE显著低于稳定组（P〈0．05）。休克组下腔静脉存在变形塌陷征象，在4个腹部层面最小直径均小于稳定组（P〈0．01）。CT增强早期，休克组肠系膜上动脉cT值为（133．2±32．4）HU，低于稳定组的（186．3±23．3）HU（P〈0．05）；下腔静脉肝脏上缘层面CT值为（133．4±20．3）HU，显著高于稳定组的（112．0±21．9）HU（P〈0．01）。而增强延迟期各血管CT值差异无统计学意义。结论部分增强螺旋CT腹部血管低灌注征象对严重创伤患者低血容量性休克早期评估有一定参考价值。

Objective To investigate the significance of hypo-perfusion signs of abdominal vessels on enhanced spiral CT in evaluation of hypovolemic shock in severe traumatic patients. Methods Clini- cal and spiral CT image data of 63 patients with severe trauma treated between January 2008 and Decem- ber 2011 were reviewed retrospectively. According to the occurrence of shock at 24 hours after spiral CT scan, the patients were divided into shock group （34 cases） and stable group （29 cases）. Blood pres- sure, heart rate, ISS, blood pH value, blood lactate （Lac） , and buffer excess （BE） and other indices on admission were analyzed and compared between the two groups. Diameter of abdominal great vessels including aorta, inferior vena cava, superior mesenteric artery and superior mesenteric vein were meas- ured on enhanced spiral CT images as well as their CT values in both early and delayed phase of enhance- ment. Results The shock group showed significantly higher ISS and blood Lac level, but significantly lower BE as compared with the stable group （ P 〈 0.05 ）. Inferior vena cava in the shock group presented signs of deformity and collapse. Minimal diameters of the four abdominal levels were all shorter in the shock group than in the stable group （P 〈0. 01 ）. In the early enhancement on spiral CT, the CT value of superior mesenteric artery was lower in the shock group than in stable group [ （ 133.2 ± 32.4） HU vs （ 186.3± 23.3 ） HU, （P 〈 0.05） ], while the CT value of inferior vena cava above the upper edge of the liver was significantly higher in shock group than in stable group [ （ 133.4 ± 20.3 ） HU vs （112.0 ± 21.9） HU, （P 〈0.01 ） ]. In the delayed enhancement on spiral CT, the CT value of each vessel presen- ted no statistical differences between the two groups. Conclusion Some hypo-perfusion signs of ab- dominal vessels on enhanced CT have some reference value on the early diagnosis of hypovolemic shock in severe traumatic patients.