猪室颤心脏骤停模型心肺复苏后急性肺损伤CT表现与病理对照

Comparison of CT findings and pathology of acute pulmonary injury after cardiopulmonary resuscitation in a pig model of cardiac arrest after ventricular fibrillation

目的对照分析猪室颤（5~10 min）心脏骤停模型心肺复苏后急性肺损伤的CT征象及其病理学表现。方法选用健康雄性家猪16只,利用电刺激诱导室颤5~10 min后进行CPR,自主循环恢复后8~10 h行CT扫描,后立刻处死猪留取肺标本进行病理观察,分析其CT征象及病理学特征。结果 16头猪室颤心脏骤停模型均制作成功,CT扫描：16头猪（100%）均可见＂磨玻璃征＂及肺实变征象,＂磨玻璃征＂占全肺体积18.4%~42.3%（平均27.3%）;肺实变病灶占全肺体积13.8%~40.5%（平均24%）。2头猪气胸（12.5%）,5头猪肋骨骨折（31.3%）,5头猪胸腔积液（31.3%）。病理镜下见病变区肺泡水肿、出血、肺泡塌陷、透明膜形成、肺毛细血管充血等。结论心跳骤停CPR后可造成不同程度的急性肺损伤,主要包括肺挫裂伤及肺缺血-再灌注损伤。CT检查可敏感反映上述病理表现,主要表现为不同程度的磨玻璃样病变及肺实变。

Objective To compare the CT and pathologic findings of acute lung injury after cardiopulmonary resuscitation（CPR） in a pig model of cardiac arrest after 5-10 minutes of ventricular fibrillation. Methods Ventricular fibrillation was induced in16 healthy male pigs using 5-10 minutes of electrical stimulation followed by CPR. After resumption of spontaneous circulation for8-10 h, CT was performed and the lungs were sacrificed immediately. CT and pathologic features were analyzed. Results CT showed ground-glass opacity（GGO） and intense parenchymal opacification（IPO） in the lungs of all 16 pigs（100%） with GGO in18.4%-42.3%（mean 27.3%） and IPO in 13.8%-40.5%（mean 24%） of the whole lung volume. There were also pneumothorax（2/16, 12.5%）, rib fracture（5/16, 31.3%）, and pleural effusion（5/16, 31.3%）. Pathologic findings included alveolar edema,hemorrhage, and collapse, transparent membrane formation, and pulmonary capillary congestion. Conclusion CPR can lead to varying degrees of acute lung injury including pulmonary contusion and lung ischemia-reperfusion injury. CT reflects the pathological features of pulmonary edema, hemorrhage and atelectasis as ＂GGO＂ and ＂IPO＂.