| 闫淯淳,郝文瀚,杨洋,刘霜,张瑾,曲东,袁新宇.胸部定量CT用于评价机械通气治疗急性呼吸窘迫综合征患儿肺复张效果及选择呼气末正压值[J].中国医学影像技术,2022,38(5):694~697 |
| 胸部定量CT用于评价机械通气治疗急性呼吸窘迫综合征患儿肺复张效果及选择呼气末正压值 |
| Quantitative chest CT for evaluating effect of mechanical ventilation for lung recruitment in children with acute respiratory distress syndrome and selecting positive end expiratory pressure |
| 投稿时间：2021-11-03 修订日期：2022-02-23 |
| DOI：10.13929/j.issn.1003-3289.2022.05.013 |
| 中文关键词: 儿童 呼吸窘迫综合征 正压呼吸 肺复张 体层摄影术,X线计算机 |
| 英文关键词:child respiratory distress syndrome positive-pressure respiration lung recruitment tomography, X-ray computed |
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| 中文摘要: |
| 目的 观察胸部定量CT评价急性呼吸窘迫综合征(ARDS)患儿肺复张效果及选择呼气末正压(PEEP)的价值。方法 回顾性分析21例接受机械通气治疗ARDS患儿的胸部CT资料,记录肺复张前、后各通气区面积变化及肺内支气管数量变化,根据病变累及面积和程度进行CT评分,建立CT评分与PEEP关系的回归模型,观察CT对评价肺复张效果及选择最佳PEEP的价值。结果 肺复张前、后各通气区面积占比差异均有统计学意义(P均＜0.001),不通气区、低通气区、正常通气区及过度通气区对PEEP的敏感程度依次降低。肺复张后,显示病变最广泛的CT层面中,双肺亚段以上支气管数量高于肺复张前(9.4±3.1 vs. 6.2±2.3;t=7.713,P＜0.001)。肺复张后各通气区的CT评分与复张时所用PEEP呈线性正相关,其回归模型如下:PEEP(5~30 cmH2O)=0.851×CT评分—5.383(P＜0.001,R2=0.684)。结论 胸部定量CT可评价机械通气治疗对于ARDS患儿的肺复张效果,有助于临床选择PEEP。 |
| 英文摘要: |
| Objective To observe the values of quantitative chest CT for evaluating the effect of mechanical ventilation(MV) for lung recruitment in children with acute respiratory distress syndrome (ARDS) and selecting positive end expiratory pressure (PEEP).Methods CT data of 21 chest ARDS children who underwent MV were retrospectively analyzed. The changes of ventilation areas, the amounts of bronchi in lung before and after lung recruitment were recorded, and the CT score was evaluated according to the area and degree of lesion involvement. Then a regression model of CT score and PEEP was established, and the value of quantitative CT for evaluating the effect of MV for lung recruitment and selecting PEEP was analyzed.Results There were significant differences of the proportions of ventilation areas before and after lung recruitment (all P＜0.001). The sensitivity to PEEP went from high to low among non ventilated area, low ventilated area, normal ventilated area and over ventilated area. On CT images showing the most extensive lesions after lung recruitment, the amount of bronchi above both lung subsets were larger than that before lung recruitment (9.4±3.1 vs. 6.2±2.3; t=7.713, P＜0.001). There was a linear positive correlation between CT score and PEEP, and the regression model was PEEP (5—30 cmH2O)=0.851×CT score-5.383 (P＜0.001, R2=0.684).Conclusion Quantitative chest CT could be used to explore the effect of MV for lung recruitment in ARDS children, which was also helpful for selecting PEEP of lung recruitment. |
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