呼吸窘迫综合征并发支气管肺发育不良早期胸部影像的研究

目的：探讨新生儿呼吸窘迫综合征（NRDS）并发支气管肺发育不良（BPD）影像学表现及其意义，以提高对该并发症的胸部影像的认识，尤其是该并发症的早期胸部影像的认识。方法：选择2006年1月-2011年11月本院新生儿科收治的符合研究条件的新生儿呼吸窘迫综合征并发支气管肺发育不良（BPD）66例患儿，随访2年，出院诊断明确，有完整胸部影像资料和完整临床资料的病例，进行回顾分析。结果：本组NRDS治疗后并发BPD66例，治疗过程中平均治疗2-3周后复查影像检查，几乎所有并发BPD患儿胸片均开始出现“两肺透亮度减低，呈‘磨玻璃’样改变，两肺野可见斑片及云絮状阴影，边界模糊不清”表现，而且治疗过程中该影像较肺水肿影像持续时间长、吸收相对较慢。66例最终均出现不同程度的网格状囊泡状阴影改变，25例此后连续拍片影像无明显变化。结论：胸部影像是临床动态观察病情变化最直观、最方便、最快捷的首先方法，新生儿支气管肺发育不良的诊断主要根据临床病史及影像学资料，胸片、CT表现虽无特征性，但具有诊断意义，尤其是高分辨率CT能提供更多有价值的征象，有助于BPD的早期诊断，为临床及患儿尽早预防治疗赢得时间。

Investigation of Early Chest Radiograohic Images of Respiratory Distress Syndrome Complicated with Bronchopulmonary Dysplasia

Objective： To investigate the imaging findings and significance of neonatal respiratory distress syndrome （ NRDS ） complicated with bronchopulmonary dysplasia （ BPD ）, and improve the understandings of complication of chest images especially the early chest images. Method： 66 newborns with neonatal respiratory distress syndrome complicated with bronchopulmonary dysplasia （ BPD ） admitted in the hospital from January 2006 to November 2011 were involved in this research. These cases who had clear discharge diagnosis, full chest image data and complete clinical data and followed for 2 years were analyzed retrospectively. Result： Review of imaging after average treatment for 2-3 weeks showed that 66 cases who treated with NRDS complicated with BPD all showed lungs brightness reduction, ground glass visible changes, planes and flocculent cloud shadow patches of both lung fields and blurred boundary performance. Furthermore, absorption was relatively slower and lasting time was relatively longer compared with image of pulmonary edema during the treatment. 66 cases ultimately had varied degrees of grid-like vesicle-like shadow of change and 25 cases had no significant change after continuous film image. Conclusion： Chest radiographic image change is the most intuitive, most convenient, fastest and first method of clinical dynamic observation. Diagnosis of neonatal bronchopulmonary dysplasia is mainly according on clinical history and imaging data. Although image of chest radiograph and CT has no significantly character, it is very important for the diagnosis. The high resolution CT can provide some valuable signs which contribute to the early diagnosis of development of BPD and gain important time for the prevention and treatment of patients.