尿毒症维持性血液透析后胸部进展性病变CT研究.docVIP

尿毒症维持性血液透析后胸部进展性病变CT研究[摘要]目的：分析长期尿毒症患者维持性血液透析后胸部进展性病变的CT表现及临床意义。方法：收集临床诊断尿毒症长期血透后胸部X线反复异常且进行性变化的46例患者的CT影像资料进行回顾性分析。结果：（1）肺部的CT表现多种多样：肺叶实变，肺组织毛玻璃密度，肺气囊或支气管扩张，肺内结节，弥漫性粟粒样密度，支气管血管间质增厚，肺气肿；（2）心脏大血管：心脏增大，心肌肥厚，肺静脉瘀血，肺动脉主干增粗，主动脉及冠状动脉血管壁钙化、心包钙化，心包脂肪垫增加；（3）胸腔积液或并叶间积液，胸膜增厚；（4）肺门、纵隔淋巴结轻、中度肿大；（5）胸壁椎体骨质增生前纵韧带钙化，肋骨病理骨折，小血管壁钙化，肌肉层萎缩脂肪层增厚。结论：尿毒症维持性长期血透后患者以心、肺病变为主，且胸部异常呈进行性、多样性CT影像改变。 [关键词]尿毒症；血液透析；计算机断层成像 [abstract]Objective：To discuss thoracic findings in long-term maintain Hemodialysis Patients based on the CT findings after X-ray and its clinical significance.Method:46 uremic patients with clinical complaints who had received long-term hemodialysis were retrospectively analyzed.lung,pleural,mediastinal,vascular,thoracic wall abnormalities related to hemodialysis therapy were assessed.Results:① various CTfindings of lung: vascular congestion, ground-glass opacity, parenchymalcarring-fibrosis,parenchymal consolidation,emphysema-bullae, broncho-vascular interstitial thickening, lung nodules, bronchiectasis;② Cardiovascularfindings: Aortic calcification, cardiomegaly, calcifications of the coronary arteries, pulmonary artery caliber enlargement;③ intrathoracic hilar and/or mediastinal lymphadenopathy enlargement was common CT findings in the hemodialysis patients; ④ pleural effusion,pleural thickening,fissural thickening;⑤thoracic wall soft-tissue calcification,costal fractures,muscular atrophy.Conclusions：The thoracic CT complications of hemodialysis were multiple and complex,cardiovascular and pulmonary parenchymal were two main topics. [KeyWords]uremia;hemodialysis;computed tomography 尿毒症引起的水、电解质和酸碱平衡失调、毒素蓄积及内分泌紊乱可导致人体多系统与脏器受损，维持性血液透析可以排出患者血中过多的毒素与水分，纠正电解质、酸碱平衡紊乱，但是血液透析是一种非持续状态的替代治疗方法，在一次数小时的透析过程中通常无法将患者体内毒素降至正常水平，而且血液透析过程中的血流动力学改变、生物相容性改变等诸多因素都可影响患者的心、肺功能，加之透析间期毒素的蓄积、水钠潴留、代谢性酸中毒，肾性贫血，以及患者的微炎症状态、营养状态等全身状态的改变均可加重心、肺等全身病变，随着透析的延长其胸部临床症状和胸部X线表现多种多样，已越来越受到人们的重视[1－4]，本研究主要在胸部X光平片基础上分析一组长期血透病人的胸部持续性、反复性病变的CT表现。 1资料与方法 1.1病例选择收集本院2004年1月至2009年7月临床诊断尿毒症并进行维持性血液透析治疗的患者，