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目的探讨严重急性呼吸综合征(SARS)患者使用无创通气后对胸部 CT 影像变化的影响及临床意义。方法回顾性分析18例 SARS 患者使用无创通气前及使用后(4～12 d)胸部 CT影像变化,并做远期(3～36个月)胸部 CT 随访。设未使用无创通气 SARS 患者27例为对照组。结果(1)使用无创通气18例患者中15例出现特殊 CT 表现:7例肺内实性病灶密度减低呈磨玻璃密度灶;5例肺下叶支气管血管束周围环形肺气肿;8例出现胸膜下肺气肿;2例出现纵隔气肿及气胸。远期随访(36个月)观察,2例患者残留胸膜下弧形线状影但有吸收。(2)对照组27例治疗过程中未出现上述 CT 表现。结论使用无创通气对 SARS 患者胸部 CT 影像表现产生影响,全面认识SARS 影像动态变化有利于合理使用无创通气治疗相关性肺炎。
Objective To investigate the effect of noninvasive ventilation on the changes of chest CT in patients with severe acute respiratory syndrome (SARS) and its clinical significance. Methods A retrospective analysis of chest CT images before and after noninvasive ventilation (4 ~ 12 days) in 18 patients with SARS was performed. Follow-up of chest CT was performed in long-term (3-36 months). 27 non-invasive non-invasive ventilation SARS patients as control group. Results (1) Among the 18 patients with noninvasive ventilation, 15 cases showed special CT findings: 7 cases with degenerative solid lesions in the lung showed density of ground glass, 5 cases of annular emphysema around the bronchovascular bundle in 5 cases, and 8 cases Subpleural emphysema; 2 cases of mediastinal emphysema and pneumothorax. Long-term follow-up (36 months) observed, 2 patients with residual pleural arcuate linear shadow but there is absorption. (2) The control group of 27 cases did not appear during the treatment of CT performance. Conclusions The use of noninvasive ventilation has an impact on the performance of chest CT images in SARS patients. A comprehensive understanding of the dynamic changes of SARS images is helpful to the rational use of non-invasive ventilation in the treatment of related pneumonia.