作　　者： (）;

机构地区： 广州市妇女儿童医疗中心

出　　处： 《分子影像学杂志》 2018年第4期426-430,共5页

摘　　要： 目的探讨儿童重症腺病毒肺炎不同阶段影像学特征与临床表现的相关性。方法回顾性分析2016年1月～2017年12月入住我院重症监护室的31例重症腺病毒肺炎病例,将患儿病程分为急性期(起病1月内)、恢复早期(起病1～6月)和恢复后期(起病6月后)3个阶段,分析急性期患儿胸片病变范围与反映肺损伤严重程度的氧和指数的相关性;分析恢复期胸部CT特征与临床表现的相关性。结果 31例患儿中25例<2岁,6例≥2岁,所有重症腺病毒肺炎患儿急性期均有持续高热、喘息气促症状,白细胞计数多在正常范围或降低,胸片改变早期主要表现双肺内带散在斑片影,随病情进展,肺部渗出快速向中外带发展,呈现肺段及大叶性肺实变,患儿胸片病灶范围越大,其肺损伤程度越重;胸片病灶范围与机械通气时间、ICU住院时间、死亡率呈正相关(P<0.05),但与总住院时间无明显相关性(P>0.05)。死亡4例均发生在急性期,15例患儿在恢复期行胸部CT检查,11例在恢复早期即表现为肺部"马赛克"征伴反复咳喘症状,在恢复后期喘息症状虽减轻,但复查胸部CT无改善,这11例患儿中<2岁10例,≥2岁仅1例,另有1例<2岁患儿恢复期后期CT表现为支气管扩张和单侧透明肺,其余3例患儿恢复期胸部CT基本恢复正常。结论儿童重症腺病毒肺炎急性期胸部X片改变可较准确反映病情严重程度与进展情况,与预后相关;而恢复期伴肺部后遗症患儿胸部CT典型"马赛克"征可长期存在,<2岁患者可能较≥2岁患者在恢复期更容易发生肺部后遗症。 Objective To explore the imaging characteristics of children with severe adenovirus pneumonia in different stages.Methods Retrospective analysis of 31 cases of severe adenovirus pneumonia in pediatrics intensive care unit from January2016 to December 2017 was conducted. The course of the disease was divided into 3 stages including acute, early recovery andlate recovery stage.We compared the clinical manifestations and imaging features of children in different stages. Results Twenty-five were younger than 2 years old. All the patients had persistent high fever, wheezing and tachypnea in acute stage.The counts of WBC was normal or lower. Chest X-ray early mainly manifested effusion in bilateral lung inner zone, with thedisease deteriorated, pulmonary effusion rapidly developmented. The exudation of X-ray in different children was consistentwith the severity of lung injury, which was consistent with the condition grew worse in one patient. Four cases died in acutestage. CT was performed in 15 children during the recovery period. Eleven children’s CT showed uneven“mosaic perfusion”inearly revcovery stage. Although wheeze alleviated, CT had no improvement in the later recovery stage. Bronchial dilation andhyaline membrane lesions has been showed in 1 cases. Conclusion The size and the density of chest X-ray in acute stage ofsevere adenovirus pneumonia in children is closely related to the severity and development of the disease. The childrenyounger than 2 years old more likely have the symptoms of continuous cough and wheeze in recovery period. Lung CTshowed“mosaic perfusion”of occlusive bronchiolitis may exist for a long time.

关 键 词： 腺病毒 重症肺炎 影像学

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