Background Hospital-acquired pneumonia （HAP） is the most common and most serious nosocomial infection for cardiac surgery patients, with high incidence and fatality ratel. It is important for cardiac surgeons to cor...Background Hospital-acquired pneumonia （HAP） is the most common and most serious nosocomial infection for cardiac surgery patients, with high incidence and fatality ratel. It is important for cardiac surgeons to correctly identify HAP, assess the severity, and then adjust anti-infection method, which can reduce the mortality rate, shorten hospitalization time, and reduce the waste of medical resources. The purpose of this research is to evaluate the application value of lung CT in diagnosis and treatment of HAP after cardiac surgery. Methods A retrospective analysis was conducted for clinical data about 76 cardiac surgery patients who were diagnosed with HAP during January to December 2013. The clinical data mainly included symptoms, physical signs, laboratory examinations （such as routine blood tests and serum procalcitonin）, and lung CT and X-ray data. Our focus is on the comparison between lung CT and X-ray data. Results The positive diagnostic rate, false negative rate, and false positive rate of lung CT were 71/76 （93.4%）, 5/76 （6.6%）, and 1/76 （1.3%） respectively. The coincidence rate of X-ray and CT was 45/76 （59.2%）, and the false negative rate of X-ray was 23/76 （30.3%）. Conclusion Lung CT is better than X-ray in diagnosis of HAP after cardiac surgery and assessment of severity, and has greater significance for guiding the rational useof antibiotics. Therefore, lung CT is worthy of application and popularization.展开更多
基金supported by the National Natural Science Fund(No.81300034)
文摘Background Hospital-acquired pneumonia （HAP） is the most common and most serious nosocomial infection for cardiac surgery patients, with high incidence and fatality ratel. It is important for cardiac surgeons to correctly identify HAP, assess the severity, and then adjust anti-infection method, which can reduce the mortality rate, shorten hospitalization time, and reduce the waste of medical resources. The purpose of this research is to evaluate the application value of lung CT in diagnosis and treatment of HAP after cardiac surgery. Methods A retrospective analysis was conducted for clinical data about 76 cardiac surgery patients who were diagnosed with HAP during January to December 2013. The clinical data mainly included symptoms, physical signs, laboratory examinations （such as routine blood tests and serum procalcitonin）, and lung CT and X-ray data. Our focus is on the comparison between lung CT and X-ray data. Results The positive diagnostic rate, false negative rate, and false positive rate of lung CT were 71/76 （93.4%）, 5/76 （6.6%）, and 1/76 （1.3%） respectively. The coincidence rate of X-ray and CT was 45/76 （59.2%）, and the false negative rate of X-ray was 23/76 （30.3%）. Conclusion Lung CT is better than X-ray in diagnosis of HAP after cardiac surgery and assessment of severity, and has greater significance for guiding the rational useof antibiotics. Therefore, lung CT is worthy of application and popularization.
文摘目的 探讨双期相双能量CT(dual-energy computed tomography,DECT)灌注成像在肺癌患者术前肺功能评估中的应用价值。方法 收集2022年11月—2024年6月于南京医科大学第一附属医院胸外科行手术治疗的ⅠA期非小细胞肺癌患者,术前均进行DECT灌注成像和肺功能检查(pulmonary function testing,PFT)。PFT观察指标包括通气功能指标如第一秒用力呼气量(forced expiratory volume in one second,FEV1)、用力肺活量(forced vital capacity,FVC)、1秒率(FEV1/FVC)、最大通气量(maximal voluntary ventilation,MVV),和弥散功能指标如一氧化碳弥散量(diffusing capacity for carbon monoxide,DLCO)、比弥散量(DLCO per liter of alveolar volume,DLCO/VA)。采用软件eXamine获得DECT灌注成像的定量参数,包括两肺及各肺叶的容积参数和灌注参数。分析两肺容积参数、灌注参数与患者的通气功能、弥散功能指标的相关性,以及各肺叶定量参数的差别。结果 吸气末相肺容积和双相容积差与FEV1、FVC呈强正相关(r=0.636,r=0.682,r=0.614,r=0.624,P<0.001),与MVV、DLCO呈中等程度正相关(r=0.499,r=0.514,r=0.549,r=0.447,P<0.001);呼气末相肺容积与DLCO/VA呈弱负相关(r=-0.295,P=0.026);容积比与FEV1、FVC、MVV、MVV占预测值百分比(MVV%)呈正相关(r=0.424,r=0.399,r=0.415,r=0.310,P<0.05);吸气末相碘含量与DLCO/VA占预测值百分比(DLCO/VA%)呈弱正相关(rs=0.292,P=0.030);呼气末相碘含量与FEV1、FVC、MVV、DLCO占预测值百分比(DLCO%)、DLCO/VA呈弱正相关(r=0.307,r=0.299,r=0.295,r=0.366,r=0.320,P<0.05),与DLCO呈中等程度正相关(r=0.439,P<0.001);吸气末相碘浓度与FEV1、FVC、MVV、MVV%呈负相关(rs=-0.407,rs=-0.426,rs=-0.352,rs=-0.277,P<0.05);呼气末相碘浓度与DLCO/VA呈中等程度正相关(r=0.403,P=0.002);碘浓度差和碘浓度比均与FEV1、FEV1占预测值百分比(FEV1%)、FVC、MVV、MVV%呈中等程度正相关(P<0.05)。肺容积、碘浓度比值均以左肺上叶最大,右肺中叶最小;肺容积差、肺容积比、肺内碘含量及肺内碘浓度差均以两肺下叶最高,右肺中叶最小。结论 双期相DECT灌注成像检查可以准确评估患者整体肺功能并量化区域肺功能。
