猪室颤心脏骤停模型心肺复苏后急性肺损伤CT表现与病理对照

目的对照分析猪室颤(5~10 min)心脏骤停模型心肺复苏后急性肺损伤的CT征象及其病理学表现。方法选用健康雄性家猪16只,利用电刺激诱导室颤5~10 min后进行CPR,自主循环恢复后8~10 h行CT扫描,后立刻处死猪留取肺标本进行病理观察,分析其CT征象及病理学特征。结果 16头猪室颤心脏骤停模型均制作成功,CT扫描:16头猪(100%)均可见"磨玻璃征"及肺实变征象,"磨玻璃征"占全肺体积18.4%~42.3%(平均27.3%);肺实变病灶占全肺体积13.8%~40.5%(平均24%)。2头猪气胸(12.5%),5头猪肋骨骨折(31.3%),5头猪胸腔积液(31.3%)。病理镜下见病变区肺泡水肿、出血、肺泡塌陷、透明膜形成、肺毛细血管充血等。结论心跳骤停CPR后可造成不同程度的急性肺损伤,主要包括肺挫裂伤及肺缺血-再灌注损伤。CT检查可敏感反映上述病理表现,主要表现为不同程度的磨玻璃样病变及肺实变。

Comparison of CT findings and pathology of acute pulmonary injury after cardiopulmonary resuscitation in a pig model of cardiac arrest after ventricular fibrillation

Objective To compare the CT and pathologic findings of acute lung injury after cardiopulmonary resuscitation (CPR) in a pig model of cardiac arrest after 5-10 minutes of ventricular fibrillation.Methods Ventricular fibrillation was induced in 16 healthy male pigs using 5-10 minutes of electrical stimulation followed by CPR.After resumption of spontaneous circulation for 8-10 h,CT was performed and the lungs were sacrificed immediately.CT and pathologic features were analyzed.Results CT showed ground-glass opacity (GGO) and intense parenchymal opacification (IPO) in the lungs of all 16 pigs (100％) with GGO in 18.4％-42.3％ (mean 27.3％) and IPO in 13.8％-40.5％ (mean 24％) of the whole lung volume.There were also pneumothorax (2/ 16,12.5％),rib fracture (5/16,31.3％),and pleural effusion (5/16,31.3％).Pathologic findings included alveolar edema,hemorrhage,and collapse,transparent membrane formation,and pulmonary capillary congestion.Conclusion CPR can lead to varying degrees of acute lung injury including pulmonary contusion and lung ischemia-reperfusion injury.CT reflects the pathological features of pulmonary edema,hemorrhage and atelectasis as "GGO" and "IPO".