胸片在新型冠狀病毒感染分流中的應用價值

The value of chest radiography in the patients triage during the outbreak of novel coronavirus pneumonia

目的探討胸片在新型冠狀病毒(COVID-19)肺炎爆發時期急重症病人分流中的應用價值。方法對2022年12月15日~2023年1月31日診斷COVID-19感染患者的首診胸片進行回顧性分析,通過對雙側肺野滲出性病變進行分區定量積分計算,探討新冠肺炎肺部滲出性病變的積分與臨床特徵的相關性。結果106例患者胸片病變分佈以雙下肺為主(χ^(2)=116.0,P<0.00);左右肺、内外帶分佈無差異主(χ^(2)=1.66,P=0.79;主χ^(2)=0.73,P=0.39);病變形態以實質與間質混合型為主。有呼吸困難症狀、指尖氧飽和度(SpO_(2))減低者,胸片積分分別高於無呼吸困難症狀及SpO_(2)正常者(t=14.81/t=8.69,P均<0.00)。門急診患者胸片積分分佈低於住院患者主(χ^(2)=9.25,P<0.05),好轉組胸片積分分佈低於死亡組患者主(χ^(2)=7.00,P<0.05)。胸片積分高者住院時間相對較長(H=6.45,P<0.05)。胸片積分與肺炎嚴重程度呈正相關關係(r=0.59,P<0.05)。結論COVID-19感染疫情爆發時期胸片在急重症分流中具有一定應用價值果。

Objective To explore the application value of chest radiography in patient triage during the outbreak of novel coronavirus pneumonia(COVID-19 pneumonia).Methods A retrospective study of the first chest X-ray of 106 COVID-19 patients from December 15,2022,to January 31,2023,was performed.A severity score was determined to quantify the extent of pulmonary exudation on chest X-ray.The correlation between severity scores on chest X-ray and the severity of clinical features of infection was statistically analyzed.Results On chest radiography,the distribution of lesions was mainly in the lower lung fields(χ^(2)=116.0,P<0.00),and there was no significant difference in the distribution of lesions in the left and right lungs(χ^(2)=1.66,P=0.79,χ^(2)=0.73,P=0.39).The lesions mainly demonstrated a mixture of consolidation and interstitial changes.Patients with symptoms of dyspnea and decreased fingertip oxygen saturation(SpO_(2))had higher chest X-ray scores than those without symptoms of dyspnea and with normal SpO_(2)(t=14.81,P<0.00,t=8.69,P<0.00).The chest X-ray scores of outpatients were mostly lower than those of inpatients(χ^(2)=9.25,P<0.05),and the scores were lower in the improved patients than in the deceased patients(χ^(2)=7.00,P<0.05).The patients with higher chest X-ray scores had a relatively longer hospital stay(H=6.45,P<0.05).The chest radiography severity scores were positively correlated with the clinical severity of COVID-19(r=0.59,P<0.05).Conclusion Chest radiography has certain application value in assessing the severity of infection which is helpful in the patient triage during the outbreak of COVID-19 infection.