Deunk Jaap, Poels Tielke C, Brink Monique, Dekker Helena M, Kool Digna R, Blickman Johan G, van Vugt Arie B, Edwards Michael John Richard
Department of Surgery, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands.
J Trauma. 2010 Feb;68(2):387-94. doi: 10.1097/TA.0b013e3181a7bdbd.
Multidetector-row computed tomography (MDCT) is a more sensitive modality as compared with conventional radiography (CR) in detecting pulmonary injuries. MDCT often detects pulmonary contusion that is not visualized by CR, defined as occult pulmonary contusion (OPC). The aim of this study was to investigate whether OPC on MDCT has implications for the outcome in blunt trauma patients.
We used prospectively collected data from 1,040 adult high-energy blunt trauma patients who were primarily presented at our emergency department and who underwent CR and MDCT of the chest. All patients with pulmonary contusion were identified and divided into two groups: The "CR/computed tomography (CT) group" consisted of patients with pulmonary contusion visible on both CR and MDCT. The "CT-only" group consisted of patients with OPC, visible exclusively on MDCT. The control group consisted of blunt trauma patients without pulmonary contusion. These groups were compared with respect to difference in mortality and other outcome measures. In addition, a multivariate analysis was performed.
Two hundred fifty-five patients suffered pulmonary contusion: The CT-only group consisted of 157 and the CR/CT group of 98 patients. The CT-only group did not differ from the control group with respect to mortality rate and other outcome measures. However, compared with the CR/CT group, mortality rate was significantly lower (8% versus 16%, p = 0.039) and most other outcome measures were significantly better in the CT-only group.
OPC on MDCT is not associated with a worse outcome as compared with patients without pulmonary contusion. OPC has a better outcome as compared with pulmonary contusion visible on both CR and MDCT.
与传统X线摄影（CR）相比，多排螺旋计算机断层扫描（MDCT）在检测肺部损伤方面是一种更敏感的检查方式。MDCT常能检测出CR无法显示的肺挫伤，即隐匿性肺挫伤（OPC）。本研究的目的是调查MDCT上的OPC对钝性创伤患者的预后是否有影响。
我们前瞻性收集了1040例主要在我院急诊科就诊并接受胸部CR和MDCT检查的成年高能钝性创伤患者的数据。所有肺挫伤患者均被识别并分为两组：“CR/计算机断层扫描（CT）组”由CR和MDCT上均可见肺挫伤的患者组成。“仅CT组”由仅在MDCT上可见的OPC患者组成。对照组由无肺挫伤的钝性创伤患者组成。比较这些组在死亡率和其他预后指标方面的差异。此外，还进行了多变量分析。
255例患者发生肺挫伤：仅CT组157例，CR/CT组98例。仅CT组在死亡率和其他预后指标方面与对照组无差异。然而，与CR/CT组相比，仅CT组的死亡率显著较低（8%对16%，p = 0.039），且大多数其他预后指标明显更好。
与无肺挫伤的患者相比，MDCT上的OPC与更差的预后无关。与CR和MDCT上均可见的肺挫伤相比，OPC的预后更好。
