胸部高分辨率CT评分评估老年髋部骨折患者急性肺损伤早期病情的价值

Value of chest high-resolution CT score in severity assessment of hip fracture-induced early acute lung injury in elderly patients

目的探讨胸部高分辨率CT(HRCT)评分在老年髋部骨折患者早期急性肺损伤(ALI)病情严重程度评估中的应用价值。方法回顾性分析我院2014年7月至2020年4月收治的289例老年髋部患者的临床资料。根据是否发生ALI将患者分为2组:ALI组(n=114),其中男36例、女78例,年龄(82.94±6.85)岁;非ALI组(n=175),其中男51例、女124例,年龄(84.42±6.31)岁。比较两组患者一般资料、胸部HRCT评分及氧合指数(PaO_(2)/FiO_(2)),并分析胸部HRCT评分与PaO_(2)/FiO_(2)的相关性。采用多元线性逐步回归分析评价HRCT总评分的影响因素。结果 ALI组患者的胸部HRCT评分[包括弥漫磨玻璃影(DGGO)、实变影(IPO)、网格影评分及HRCT总评分]和PaO_(2)/FiO_(2)均高于非ALI组患者(P<0.001)。相关分析结果显示,ALI组患者PaO_(2)/FiO_(2)与DGGO评分、HRCT总评分呈显著负相关关系(P<0.001),且PaO_(2)/FiO_(2)与HRCT总评分的相关性更高。逐步回归分析结果显示,DGGO、IPO及网格影评分均为HRCT总评分的独立影响因素。结论胸部HRCT评分与PaO_(2)/FiO_(2)存在相关性,对老年髋部骨折患者ALI早期病情严重程度评估具有重要价值。

Objective To investigate the value of chest high-resolution computed tomography(HRCT)score in evaluating the severity of hip fracture-induced early acute lung injury(ALI)in the elderly patients.Methods The clinical data of 289 elderly hip fracture patients in Chongqing Traditional Chinese Medicine Hospital from July 2014 to April 2020 were retrospectively analyzed.All patients were divided into two groups,including an ALI group(n=114,36 males and 78 females at age of 82.94±6.85 years)and a non-ALI group(n=175,51 males and 124 females at age of 84.42±6.31 years).General information,chest HRCT scores and PaO_(2)/FiO_(2) were compared between the two groups.Correlation analysis was used to compare the relationship between chest HRCT scores and PaO_(2)/FiO_(2).Multiple linear stepwise regression analysis was applied to evaluate the effective extent of the diffuse ground glass opacity(DGGO),intense parenchymal opacification(IPO),and reticulation HRCT scores to the overall HRCT scores.Results The DGGO scores,IPO scores,reticulation scores,overall HRCT scores and PaO_(2)/FiO_(2) were higher in the ALI group than those in the non-ALI group(P<0.001).In the ALI group,correlation analysis showed that DGGO,overall HRCT scores were in significantly negative correlation with PaO_(2)/FiO_(2)(P<0.001).In addition,the correlation among PaO_(2)/FiO_(2) and overall HRCT scores was more significant than that of DGGO scores.Multiple stepwise regression analysis indicated that DGGO,IPO,and reticulation scores were independent influencing factors for overall HRCT scores.Among the influencing factors,DGGO scores had the greatest impact,then IPO scores and reticulation scores.The HRCT signs of DGGO,IPO,and reticulation appeared simultaneously had the greatest effects on the overall HRCT scores.Conclusion The chest HRCT score,which is associated with PaO_(2)/FiO_(2),also can be used in the severity assessment of elderly patients with early ALI caused by hip fracture.