本文選題：特重度燒傷 + 吸入性損傷�。� 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的探討特重度燒傷伴吸入性損傷時(shí)支氣管壁厚度與病死率的關(guān)系,支氣管壁厚度動(dòng)態(tài)變化趨勢,確定支氣管壁厚度的預(yù)測診斷價(jià)值。方法選取2016年7月~2016年11月急診收治的特重度燒傷伴吸入性損傷患者43例,所有患者均在入院時(shí)完成纖維支氣管鏡(FOB)檢查,確定其存在吸入性損傷。分別于入院時(shí)、24h、3d、7d、14d行胸部高分辨率CT(HRCT)檢查,測量右肺上葉支氣管主干的支氣管壁厚度(BWT)。分析BWT與病死率的關(guān)系。依據(jù)患者14天內(nèi)預(yù)后情況分為存活組、死亡組,分析不同預(yù)后不同時(shí)段的BWT變化趨勢。利用ROC曲線比較入院時(shí)BWT和FOB預(yù)測肺炎及死亡的診斷價(jià)值。結(jié)果入院時(shí)、24h、3d、7d、14d的BWT與病死率之間均呈正相關(guān)(r=0.763、r=0.884、r=0.973、r=0.960、r=0.807,P0.001)。死亡組患者入院時(shí)支氣管壁厚度(BWT)顯著高于存活組患者(P0.001),死亡組患者BWT在入院后迅速升高,存活組患者BWT在入院后緩慢升高,均于入院24小時(shí)達(dá)峰值。存活組患者BWT在24h~3天之間出現(xiàn)“陡坡式”下降,并且在入院后第7~14天,出現(xiàn)BWT下降平坦期;而死亡組患者BWT在入院24h~3天下降緩慢,呈現(xiàn)下降平坦期,入院3天后呈現(xiàn)“拋物線形”下降,死亡組患者BWT顯著下降時(shí)間遲于存活組,且死亡組患者BWT于入院第14天仍然顯著高于存活組(P0.001),大約為存活組患者BWT的1.44倍。入院時(shí)支氣管壁厚度2.45mm時(shí),預(yù)測肺炎的ROC曲線下面積為(0.954±0.044)(95%CI:0.867~1.000),入院時(shí)支氣管壁厚度預(yù)測肺炎的準(zhǔn)確性為95.35%,靈敏性為85.71%,特異性為97.22%,陽性預(yù)測值85.71%,陰性預(yù)測值為97.22%;入院時(shí)支氣管壁厚度2.75mm時(shí),預(yù)測死亡的ROC曲線下面積為(0.956±0.038)(95%CI:0.882~1.000),入院時(shí)支氣管壁厚度預(yù)測死亡準(zhǔn)確性為90.70%,靈敏性為83.33%,特異性為96%,陽性預(yù)測值93.75%,陰性預(yù)測值為88.89%。入院時(shí)纖維支氣管鏡簡明損傷評(píng)分分級(jí)1.5時(shí),預(yù)測肺炎的ROC曲線下面積為(0.679±0.099)(95%CI:0.484~0.873),入院時(shí)纖維支氣管鏡簡明損傷評(píng)分分級(jí)預(yù)測肺炎的準(zhǔn)確性為62.79%,靈敏性為75%,特異性為60%,陽性預(yù)測值30%,陰性預(yù)測值為91.30%;入院時(shí)纖維支氣管鏡簡明損傷評(píng)分分級(jí)1.5時(shí),預(yù)測死亡的ROC曲線下面積為(0.880±0.057)(95%CI:0.768~0.991),入院時(shí)纖維支氣管鏡簡明損傷評(píng)分分級(jí)預(yù)測死亡準(zhǔn)確性為81.40%,靈敏性為87.50%,特異性為77.78%,陽性預(yù)測值70%,陰性預(yù)測值為91.30%。入院時(shí)BWT預(yù)測診斷價(jià)值優(yōu)于入院時(shí)FOB簡明損傷評(píng)分分級(jí)。結(jié)論BWT測量是一種簡便易行、無創(chuàng)高效、可重復(fù)性強(qiáng)、可量化吸入性損傷程度及預(yù)測預(yù)后的檢查方法。BWT有利于彌補(bǔ)纖維支氣管鏡的局限性,開展治療性干預(yù)。
[Abstract]:Objective to investigate the relationship between bronchial wall thickness and mortality in severe burn patients with inhalation injury, and to determine the predictive diagnostic value of bronchial wall thickness.Methods 43 cases of severe burn with inhalation injury were selected from July 2016 to November 2016. All the patients were examined with fiberoptic bronchoscopy (FOB) on admission to determine the presence of inhalation injury.The thickness of the bronchial wall of the main trunk of the upper lobe of the right lung was measured by HRCT at 24 h, 3 d, 7 d and 14 d after admission.The relationship between BWT and mortality was analyzed.According to the prognosis of 14 days, the patients were divided into survival group and death group. The trend of BWT changes in different prognosis and different period was analyzed.ROC curve was used to compare the diagnostic value of BWT and FOB in predicting pneumonia and death.Results there was a positive correlation between BWT and fatality rate at 24 h, 3 d, 7 d and 14 d after admission. There was a positive correlation between BWT and fatality rate.The bronchial wall thickness in the death group was significantly higher than that in the survival group (P 0.001). The BWT of the patients in the death group increased rapidly after admission, and the BWT increased slowly in the survival group, reaching the peak at 24 hours after admission.In the survival group, the BWT decreased "steeply" between the 24h~3 days and the BWT decreased flat on the 7th and 14th day after admission, while the BWT in the death group decreased slowly on the 24h~3 day after admission, showing a flat phase.Three days after admission, there was a "parabola" decline. The BWT of the dead group was significantly lower than that of the survival group, and the BWT of the death group was still significantly higher than that of the surviving group on the 14th day, which was about 1.44 times of the BWT of the surviving group.On admission, bronchial wall thickness (2.45mm),The area under the ROC curve for predicting pneumonia was 0.954 鹵0.044 / 95CI: 0.8671.000. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of bronchial wall thickness on admission were 95.3535, 85.71, 97.22, 85.71 and 97.22, respectively.The area under the ROC curve for predicting death was 0.956 鹵0.038 / 95 CI: 0.882 / 1.000. The accuracy of predicting death was 90.70 on admission, the sensitivity was 83.33, the specificity was 96 and the positive predictive value was 93.75 and the negative predictive value was 88.89.The brief injury score of fiberoptic bronchoscopy was 1.5 at admission.The area under the ROC curve for predicting pneumonia was 0.679 鹵0.099 ~ 95CI: 0.484 / 0.8730.The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of fiberoptic bronchoscopy on admission were 62.79, 75, 60, 30 and 91.30, respectively.The concise injury score of tube mirror was 1.5.The area under the ROC curve for predicting death was 0.880 鹵0.057, CI: 0.768 / 0.991g. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value were 81.40, 87.50, 77.78, and 91.30, respectively.The predictive value of BWT on admission was better than that on admission by FOB concise injury score.Conclusion BWT measurement is a simple, non-invasive, effective and reproducible method. It can quantify the degree of inhalation injury and predict the prognosis. BWT is helpful to remedy the limitation of fiberoptic bronchoscopy and to carry out therapeutic intervention.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R644;R816.4

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 張濤;李孝建;鄧忠遠(yuǎn);湯文彬;;血清PCT、IL-6和IL-10水平對(duì)重度燒傷伴膿毒癥的診斷價(jià)值及臨床意義[J];中國實(shí)驗(yàn)診斷學(xué);2016年08期

2 李杰;傅浩;余瓊;譚維義;黃梅芳;詹振鵬;谷美玉;陳雪梅;;中性粒細(xì)胞表面分子CD64及炎性因子與燒傷感染的相關(guān)性研究[J];現(xiàn)代診斷與治療;2016年14期

3 張偉峰;徐文舉;李翔;胡楠;馬常明;;小兒面部燒傷合并吸入性損傷的臨床特點(diǎn)分析[J];西南國防醫(yī)藥;2016年07期

4 徐郁萍;龔芳;顧金花;;燒傷膿毒癥患兒血清炎性因子TNF-α、IL-6水平及其臨床意義[J];國際檢驗(yàn)醫(yī)學(xué)雜志;2016年10期

5 賈赤宇;舒彬;;急性吸入性肺損傷發(fā)病機(jī)制和臨床診治的相關(guān)問題[J];中華損傷與修復(fù)雜志(電子版);2016年02期

6 秦培順;龔裕強(qiáng);;燒傷后吸入性損傷相關(guān)分子機(jī)制的研究進(jìn)展[J];中華創(chuàng)傷雜志;2016年03期

7 王向林;張利娜;;纖維支氣管鏡在成批吸入性損傷中的應(yīng)用評(píng)價(jià)[J];中國實(shí)用醫(yī)藥;2016年07期

8 馮勝娟;賈赤宇;劉真;呂曉武;;重度煙霧吸入性損傷發(fā)病機(jī)制及治療研究進(jìn)展[J];中華燒傷雜志;2016年02期

9 胡凡剛;梁文杰;劉德斌;李慎江;張海峰;鄭金洋;;急性煙霧吸入性肺損傷診治分析[J];中國輻射衛(wèi)生;2016年01期

10 雷少軍;沙德潛;劉洪琪;;重度、特重度燒傷患者首次白細(xì)胞計(jì)數(shù)影響因素的相關(guān)分析及臨床意義[J];中華損傷與修復(fù)雜志(電子版);2016年01期

相關(guān)碩士學(xué)位論文 前1條

1 楊志輝;急性硫化氫中毒肺損傷的分期影像學(xué)表現(xiàn)及CT評(píng)分與氧合指數(shù)相關(guān)性研究[D];浙江大學(xué);2015年

，

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