CT检查在尿毒症肺炎诊治中的临床价值

h e Clinic Value of Computed Tomography Examination in the Treatment of Uremic Pneumonia

目的评估CT检查对尿毒症肺炎患者临床诊断指导、疗效评估的价值。方法回顾2011年2月-2013年1月64例尿毒症肺炎患者入院和治疗后临床表现、病程转归,对比分析CT影像改变和临床疗效关系。结果 64例尿毒症肺炎患者胸部CT表现:出现肺淤血27例,肺间质水肿51例,肺泡渗出水肿8例,肺间质纤维化15例,各个病程阶段有不同的影像表现;CT检查清楚显示浆膜腔积液和心脏形态改变;临床血液透析、对症治疗后复查CT所见:27例肺淤血、51例肺间质水肿及42例胸腔积液治疗前后对比CT影像改变差异有统计学意义(P<0.001);8例肺泡水肿治疗前后肺部影像表现有差异(P<0.05);15例肺间质纤维化患者治疗前后肺部CT影像无变化,14例患者伴有心包积液,经过治疗仍有6例积液未吸收,两者差异无统计学意义(P>0.05)。结论尿毒症肺炎的诊断主要依靠影像诊断,CT的影像表现可对尿毒症肺炎提供临床分期,对治疗方法的选择和疗效评估起重要作用。

Objective To evaluate the value of computed tomography examination in the clinical diagnosis guidance and therapeutic effect assessment for patients with uremic pneumonia. Methods We reviewed the clinical situation and pathogenesis turnover of 64 cases of uremic pneumonia from February 2011 to January 2013, and analyzed the correlation between image modification and treatment effectiveness. Results Sixty-four cases of uremic pneumonia had different image manifestations in each phase of the disease course, including 27 cases of pulmonary venous pleonaemia, 51 of lung interstitial edema, 8 of pulmonary alveoli effusion, and 15 of pulmonary interstitial fibrosis. Dropsy of serous cavity and the heart shape could be viewed by CT scanning. CT rechecking was carried out after hemodialysis and symptom- targeted treatment. The results showed that CT results of 27 cases of pulmonary venous pleonaemia, 51 cases of edema in the interstitial tissue and 41 cases of pleural effusion changed significantly after treatment （P 〈 0.001）; the image manifestations of 8 cases of pulmonary alveoli edema also changed significantly （P 〈 0.05）; the CT result of 15 cases of pulmonary interstitial fibrosis had no change; six cases among the fourteen cases of pericardial effusion were not absorbed by treatment （P 〉 0.05）. Condusions The diagnosis of uremic pneumonia mainly depends on imaging results. CT scanning plays an important role on the determination of clinical stage, the choice of therapeutic method, and evaluation of curative effect for uremic pneumonia.