重症肺炎床旁超声、HRCT影像学表现及临床应用价值研究

Study on Imaging Features and Clinical Value of Bedside Ultrasound and HRCT in Severe Pneumonia

目的分析重症肺炎床旁超声、HRCT影像学表现及临床应用价值。方法收集在本院2017年8月至2019年12月收治的71例确诊为重症肺炎者临床资料,均进行床旁超声及HRCT检查。分析患者床旁超声、HRCT影像学表现及其临床使用价值。结果重症肺炎常见多个肺叶受累,60.56%为右肺叶,并伴有多个器官受累。HRCT表现:81.69%肺内存在团片状、斑片状以及结节状稍高密度影,边界不清晰,可见支气管影。肺部存在实变者有49例(69.01%),非实变者22例(30.98%)。床旁超声:53.52%可见肺部实变、70.42%可见胸膜下病变、49.29%胸膜病变、69.01%肺炎旁积液。经床旁超声检查,非实变者无肺部实质改变,且其胸膜下病变个数、胸膜改变肋间个数、均高于肺实变者(P<0.05)。结论重症肺炎在床旁超声、HRCT表现上均存在一定特异性,可为临床诊断提供确切资料;床旁超声更适用于行动不便、无法下床活动者以及病情危重无法搬动外出检查者,在临床工作中可根据患者实际情况选择检查手段。

Objective To analyze the bedside ultrasound and HRCT imaging manifestations of severe pneumonia and its clinical application value.Methods The clinical data of 71 patients diagnosed with severe pneumonia admitted in our hospital from August 2017 to December 2019 were collected and all were examined by bedside ultrasound and HRCT.The bedside ultrasound and HRCT imaging manifestations and their clinical value were analyzed.Results Severe pneumonia often involves multiple pulmonary lobe,60.56%of which are involvement of right lobe with involvement of multiple organ.HRCT manifestations showed in the 81.69%lungs,there were mass-like,patchy,and nodular slightly highdense shadows,with unclear borders and bronchial shadows.There were 49 cases with pulmonary consolidation(69.01%)and 22 cases with pulmonary non-consolidation(30.98%).Bedside ultrasound showed 53.52%patients can be seen with pulmonary consolidation,70.42%patients can be seen with subpleural lesions,49.29%patients can be seen with pleural lesions,and 69.01%patients can be seen with parapneumonic effusions.According to HRCT examination,the patients with pulmonary non-consolidation had no pulmonary parenchymal change,and their number of subpleural lesions,and their number of intercostal pleural changes were higher than those of patients with pulmonary consolidation(P<0.05).Conclusion Severe pneumonia has some specificities in bedside ultrasound and HRCT,which can provide accurate data for clinical diagnosis.Bedside ultrasound is more suitable for people unable to move freely,unable to get out of bed,and unable to move out for examination.In clinic,we can choose the examination according to the actual situation of patients.