30例体外膜肺氧合辅助心肺复苏治疗患者影像学特点分析

Radiologic Features of 30 Patients Receiving Extracorporeal Cardiopulmonary Resuscitaiton

目的总结体外膜肺氧合辅助心肺复苏治疗(ECPR)的心源性心脏骤停(CA)患者的胸部影像学特点。方法回顾性分析2015年5月至2021年3月所有ECPR患者的胸部影像学特点。纳入肺部病变符合重力依赖性分布的患者,分别依据胸部正位X线片和胸部CT平扫计算RALE评分和CT评分。Bland-Altman分析法分析两名影像科医师评分的一致率。结果最终纳30例患者,其中男26例,女4例,平均年龄(46±18)岁,常规心肺复苏时间(CCPR)(38±14)min、ECMO穿刺至转机时间(15±2)min、CA发生至CT检查时间92 min(29 min,79 min)。30例患者中,磨玻璃病变及斑片状实变发生率最高,为90%(27/30),小叶间隔增厚及支气管血管束征分别为86.7%(26/30)、73.3%(22/30),支气管充气征56.7%(17/30),心包积液的发生率最低,为20%(6/30)。Bland-Altman分析法评价影像科医师之间评分的一致率为96.7%[RALE评分95%CI(-5.475,5.609);CT评分95%CI(-6.969,4.103)]。双肺RALE评分37.4±11.1,左、右肺RALE评分无统计学差异(20.3±6.8 vs.17.8±7.1)(P=0.091)。肺上区CT积分(4.1±2.3)显著低于肺中区(9.7±3.4)及肺下区(15.1±3.6)(P<0.01),肺中区和肺下区之间CT评分也有统计学差异(P<0.01)。肺前区CT评分显著低于肺后区(16.4±2.9 vs.21.3±4.5)(P<0.01)。肺水肿占比34.5±13.5(%)。结论心源性CA患者的胸部CT可表现为重力依赖性分布的特点,这一特征性影像的临床意义尚不清楚,需要进一步的研究。

Objective To analyze the chest radiographic manifestations in patients after receiving ECPR who were diagnosed with confirmed cardiogenic CA Methods All patients with ECPR were enrolled from May 2015 to March 2021 and the chest radio-graphic characteristics were retrospectively analyzed.Patients with gravity-dependent distribution of lesions in chest CT scan were further explored.The radio-graphic and assessment of lung oedema(RALE)score and CT score were calculated respectively.The consistency between two radiologists was analyzed by Bland-Altman method comparison.Results A total of 30 patients including 26 males and 4 females(meaning age,46±18 years)were investigated.The time of conventional cardiopulmonary resuscitation(CCPR)was(38±14)min,the time from ECMO puncture to transfer was(15±2)min,and the time from CA to CT examination was92(29,79)min.Among the 30 patients,the incidence of ground glass lesions and patchy consolidation was the highest,90%(27/30),interlobular septal thickening and bronchovascular bundle sign were 86.7%(26/30),73.3%(22/30),bronchial inflation sign was 56.7%(17/30),and pericardial effusion was the lowest,20%(6/30).The consistency between two radiologists was 96.7%[RALE 95%CI(-5.475,5.609);CT scores 95%CI(-6.969,4.103)].RALE of bilaterial lungs was 37.4±11.1.There was no significant difference between the left(20.3±6.8)and right(17.8±7.1)lung(P=0.091).The CT scores of the upper zone(4.1±2.3)was significantly lower than those of middle(9.7±3.4)and lower zones(15.1±3.6)(P<0.01).The CT scores of the anterior zone(16.4±2.9)were significantly lower than those of the posterior zone(21.3±4.5)(P<0.01).Lung edema ratio was 34.5±13.5(%).Conclusion CT imaging of some ECPR patients with confirmed cardiogenic CA showed gravity-dependent lesion distribution.The association between the distinct manifestations and clinical outcomes was still unknown.