呼吸机相关性肺炎患者CT表现特点分析

Features of CT Manifestations of Patients with Ventilator-associated Pneumonia

目的分析呼吸机相关性肺炎(VAP)患者的CT表现特点。方法回顾性分析2017年1月-2018年2月我院120例VAP患者的临床病例及CT影像学检查资料,经多平面重组行图像后处理,记录患者病变分布、形态、密度等CT表现特点。结果95例(79.17%)均为双侧分布,对称性分布78例(65.00%),且以双肺下叶对称最为常见(46.67%),可观察到双肺下叶后部胸膜下区有明显高密度影,120例均可观察到明显右肺下叶病变,仅右肺下叶病变31例(25.83%),其余89例均累及双肺下叶病变,单灶均位于右肺下叶30例(25.00%);120例患者共264处病灶,其中253处(95.83%)位于背侧胸膜下区;111例(92.50%)气管插管前CT检查无肺内异常病灶,气管插管后均出现新的浸润病灶,105例(87.50%)均可观察到背部胸膜下区类新月形软组织密度影,19例(15.83%)可观察到磨玻璃样改变,14例(11.67%)可观察到与支气管肺炎及间质性肺炎CT表现相似的沿肺纹理分布的斑点状浸润影,2例(1.67%)可观察到支气管气相。结论 VAP患者的CT表现在病变分布及形态上具一定特征性,可为VAP的诊断提供影像学依据,指导患者病情的判断、治疗方案的制定及拔管时间的选择。

Objective To analyze the features of CT manifestations of patients with ventilator-associated pneumonia（VAP）. Methods The clinical cases and CT imaging data of 120 VAP patients in our hospital from January 2017 to February 2018 were analyzed, and the features of CT manifestations, such as lesion distribution, morphology and density were recorded according to the multiplane reconstruction for image processing. Results 95 cases（79.17%） were bilaterally distributed and 78 cases（65.00%） were the symmetrically distributed, and the lower lobe symmetry of double lungs was the most common（46.67%）, and obvious high density shadow was seen subpleural area of posterior lower lobe of double lungs. Obvious lower lobe lesions of right lung were observed in 120 cases, and 31 cases（25.83%） were only lower lobe lesions of right lung and the remaining 89 cases were all involved in lower lobe lesions of double lungs [30 cases（25.00%） single lesions were located in the lower lobe of right lung. A total of 264 lesions were performed in 120 patients, of which 253（95.83%） were located in the dorsal subpleural area. 111 cases（92.50%） were without abnormal lung lesions by CT before tracheal intubation and were with new infiltrative lesions after tracheal intubation, and crescent-like soft tissue density shadow in the dorsal subpleural area were observed in 105 cases（87.50%）, and the changes of ground glass opacity were observed in 19 cases（15.83%）, and the patch-like infiltration shadow distributed along the lung markings which were similar to CT findings in bronchopneumonia and interstitial pneumonia were observed in 14 cases（11.67%）, and air bronchogram signs were observed in 2 cases（1.67%）. Conclusion CT manifestations of VAP patients have certain features in the distribution and morphology of lesions, and they can provide imaging basis for the diagnosis of VAP, guide the condition judgment, formulate the treatment plans and select the extubation time.