急性主动脉夹层患者肺部改变的多排CT研究

摘要

目的探讨多排CT（MDCT）上主动脉夹层患者的肺部改变特征及发生率。方法观察71例主动脉夹层首诊患者的MDCT上肺部改变，分析并比较Stanford A型和B型患者的肺部改变情况，随访主动脉腔内覆膜支架置入术治疗和保守治疗前后患者的肺部改变。结果肺间质病变（51例，71.8%）、心包积液/心脏增大（28例，39.4%）、胸腔积液（18例，25.4%）、肺不张（13例，18.3%）在主动脉夹层患者的MDCT上最为常见，发生率相对较高；在Stanford A型和B型患者肺部MDCT改变中，心包积液/心脏增大发生率的差异有统计学意义，A型多于B型〔51.2%（21/41例）比23.3%（7/30例），P＝0.011〕；主动脉腔内覆膜支架置入术治疗和保守组治疗前后各种肺内改变均未见明显变化，差异均无统计学意义（均P＞0.05）。结论通过MDCT图像观察肺部改变，有助于制定正确的临床治疗计划，提高MDCT在主动脉夹层诊断和随访中的临床价值。%　　Objective To investigate the pulmonary findings and their incidences in patients with acute aortic dissection on multidetector CT(MDCT). Methods Seventy one cases with aortic dissection diagnosed with MDCT were included in this study. The characteristics and incidences of pulmonary findings were analyzed. The difference of pulmonary findings between Stanford A and Stanford B type was compared. The changes of pulmonary findings before and after aortic stent therapy and conservative therapy were followed up and discussed. Results The most common findings were interlobular septal thickening(51 cases,71.8%),pericardial effusion and/or cardiac enlargement (28 cases,39.4%),pleural effusion(18 cases,25.4%),and atelectasis(13 cases,18.3%)on the MDCT of such patients,and the incidences of these findings were relatively high. In the comparison between Stanford-A and Stanford-B patients,the difference in the incidence of pericardial effusion and/or cardiac enlargement was statistically significant, in Stanford A type this finding being more than that in B type〔51.2%(21/41 cases)vs. 23.3%(7/30 cases), P=0.011〕. There were no significant differences in the various pulmonary changes before and after endovascular stent-graft implantation in aorta and conservative treatment(all P>0.05). Conclusion The investigation on the changes of pulmonary findings on MDCT graphs is helpful in making a proper clinical therapeutic plan and elevates the clinical value of MDCT in the diagnosis and follow-up for patients with aortic dissection.