【作者】 张霞；

【导师】 刘怀军；

【作者基本信息】 河北医科大学 ， 影像医学与核医学， 2014， 硕士

【摘要】 目的：研究心源性肺水肿的床旁DR表现，分析心源性肺水肿的胸片表现及征象，寻求诊断心源性肺水肿的简单易行的评分标准，提高肺水肿的阳性诊断率；方法：分析我院心内科心源性肺水肿患者90人，分析在急性心肌梗死及非急性心肌梗死（慢性心力衰竭急性加重、瓣膜病、心肌病等）引起的心源性肺水肿其临床表现、征象及实验室检查有无区别；以及根据X线阅片原则及指南制定心源性肺水肿的新的评分标准，并分析两种方法的相关性；测量并描述性分析所有病人的血管蒂宽度与心胸比率。结果：1两种不同成因的心源性肺水肿（急性心肌梗死和非急性心肌梗死，下同）临床症状及征象分析，其中放射痛、气短、颈静脉充盈或怒张、双下肢水肿及咳嗽、咳痰(P<0.05)，有统计学差异。两种不同成因的心源性肺水肿的放射痛[频数（构成比），下同]分别为15(31.3)和1(2.4)，气短为18(37.5)和32(76.2)，颈静脉充盈或怒张为1(2.1)和9(21.4)，双下肢水肿为9(18.8)和21(50.0)，咳嗽为7(14.6)和17(40.5)，咳痰为7(14.6)和17(40.5)。且放射痛在急性心肌梗死引起的肺水肿中更常见，而气短、颈静脉充盈或怒张、双下肢水肿及咳嗽、咳痰在其它原因引起的非急性心肌梗死引起的肺水肿中更为常见。2在心源性肺水肿的两种不同成因中左心室舒张功能障碍和收缩功能障碍有差异(P<0.05)，左室舒张功能障碍在两种类型的心源性肺水肿[频数（构成比），下同]分别为31(64.1)和18(43.3)，左室收缩功能障碍分别为40(76.9)和27(63.3)。且左室舒张障碍在急性心梗引起的心源性肺水肿较为常见，而左室收缩功能障碍在非急性心梗引起的其他原因引起的心源性肺水肿较为常见。3急性心肌梗死的男性患者的左室前后径（均数±标准差，下同）（54.6±7.9mm）及左房前后径(37±4.4mm)、女性患者的左室前后径(50.0±6.2mm)及非急性心肌梗死女性患者的左室前后径(51.0±8.3mm）及左房前后径(40±6.4mm)与正常值存在差异(P<0.05),有统计学意义，且较正常增大。4新评分系统与PCS评分是正相关的(相关系数为0.503，P<0.05)；新评分系统与PCS评分有差异，两者的差值为2.90076±5.21920，t值=5.27，P=0.00(P<0.05)，统计学有意义，两种方法的测定结果不同，新评分分数值较高；5在急性心肌梗死患者中和非急性心肌梗死患者中两种评分是相关的(相关系数分别为0.599，0.406，P<0.05)；结论：新评分系统可以更好的根据胸片征象诊断心源性肺水肿；尽管如此，但是心源性肺水肿的诊断仍旧需要结合临床症状及实验室检查。更多还原

【Abstract】 Objective: To study the signs of the cardiac pulmonary edema by DRbedside chest X-rays;To seek and make a simpler criterion in order to increasepositive rate for diagnosis of cardiogenic pulmonary edema.Methods:90people from the department of cardiology were diagnosedwith cardiac pulmonary edema, and admitted to hospital.The differencebetween acute myocardial infarction(AMI) and non-AMI(acute exacerbationof chronic heart failure, heart valvular disease, cardiomyopathy, and so on)intheir clinical manifestations, signs and laboratory tests was analysed.A newscoring criterion for cardiac pulmonary edema was made according to theprinciples and guidelines on X-ray film-reading,and the correlation of PCSand the new scoring was analysed;Measurement and descriptive analysis ofthe vascular pedicle width and cardiothoracic ratio of all patients were made.Results:1The clinical symptoms and signs of two kinds of cardiogenicpulmonary edema(AMI and non-AMI,the same below)was analysed.Inradiation pain, shortness of breath, jugular venous filling orengorgement,edema of lower extremity,cough and sputum(P<0.05),there wasstatistical difference. Radiation of pain of two different causes of cardiogenicpulmonary edema [frequency (ratio),] were15(31.3) and1(2.4),shortness ofbreath were18(37.5) and32(76.2),jugular venous filling or engorgement were1(2.1)and9(21.4), edema of lower extremity were9(18.8) and21(50),coughwere7(14.6) and17(40.5),sputum were7(14.6) and17(40.5),respectively.Moreover,radiation pain in pulmonary edema is morecommon in AMI,and shortness of breath,jugular venous filling orengorgement,edema of lower extremity and cough,sputum in non-AMIcausing pulmonary edema is more common. 2There was difference between left ventricular diastolic dysfunction andsystolic dysfunction of cardiogenic pulmonary edema in two different causes,(P<0.05),left ventricular diastolic dysfunction in acute cardiogenic pulmonaryedema[frequency (ratio)] were31(64.1) and18(43.3),left ventricular systolicdysfunction were40(76.9)and27(63.3) respectively.Meanwhile,leftventricular diastolic dysfuntion was more common in the AMI causingcardiogenic pulmonary edema,and left ventricular systolic dysfunction innon-AMI.3The anteroposterior diameter of left heart atrium and left heart ventriclein the men acute myocardial infarction was (54.6±7.9mm)and(37±4.4mm),the anteroposterior diameter of left heart ventricle in the women acutemyocardial infarction was (50.0±6.2mm),the anteroposterior diameter of leftheart atrium and left heart ventricle in the women non-AMI were (40±6.4mm)and(51.0±8.3mm).The above data compared with the normal valuehad statistical significance(P<0.05), and bigger than the normal.4A new scoring criterion and PCS scoring criteria wererelevant(coefficient correlation=0.503,P<0.05)new scoring criteria werehigher than PCS,the difference was2.90076±5.21920(t=5.27,P<0.05).5Two kinds of the score of acute myocardial infarction and non-acutemyocardial infarction was relevant(coefficientcorrelation=0.599,0.406,P<0.05)Conclusion:According to the new criteria of bedside chest DR,althoughwe can determine directly cardiac pulmonary edema through the signs, thediagnosis of cardiac pulmonary edema still needs clinical symptoms coupledwith laboratory examinations.更多还原