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目的 探讨老年重症患者左心功能不全肺水肿与床边胸部计算机 X线摄影 (CR)血管蒂的宽度 (VPW)和心胸比例 (CTR)的测量值对老年重症患者左心功能不全肺水肿的诊断价值。方法 对 60例老年重症患者左心功能不全肺水肿患者 (肺水肿组 )和 60例无左心功能不全表现的老年重症患者患者 (对照组 )床边胸部 CR在工作站进行 VPW和 CTR的测量。结果 VPW和 CTR的平均值在肺水肿组显著高于对照组 (P<0 .0 0 1 ) ,对照组和肺水肿组 VPW≥ 70 mm者分别占 1 1 .7% (7/ 60 )和 96.7% (58/ 60 ) ,差异非常显著。其中对照组无 >80 mm者而肺水肿组占33.3% ,对照组和肺水肿组 CTR≥ 0 .54者分别占 48.3% (2 9/ 60 )和 93.3% (56/ 60 ) ,差异非常显著 ,其中对照组和肺水肿组 CTR≥ 0 .63分别为8.3%和 35%。结论 床边胸部 CR的 VPW测量值可以作为老年重症患者左心功能不全肺水肿诊断的一个重要参考标准 ,结合心胸比例的测量对老年肺水肿的诊断有一定帮助作用 ,同时也有一定限度。
Objective To investigate the diagnostic value of left ventricular dysfunction pulmonary edema in elderly critically ill patients with left ventricular dysfunction pulmonary edema and bedside chest computed radiography (VPW) and cardiothoracic ratio (CTR) value. Methods The bedside chest CR was measured in 60 elderly patients with severe acute pulmonary edema (pulmonary edema group) and 60 elderly patients with severe left ventricular dysfunction (control group). Results The average values of VPW and CTR in pulmonary edema group were significantly higher than those in control group (P <0.01), and those in control group and pulmonary edema group were 71.7% (7/60) and 96.7% (58/60), the difference is very significant. There was no significant difference between the control group and the pulmonary edema group (P> 0.05). The control group and the pulmonary edema group had CTR> 0.54, accounting for 48.3% (29/60) and 93.3% (56/60) , Of which CTR≥0.63 in control group and pulmonary edema group were 8.3% and 35% respectively. Conclusions The VPW measurement of bedside chest CR can be used as an important reference for the diagnosis of pulmonary edema in patients with severe left heart disease in elderly. The measurement of cardiothoracic proportion may be of help in the diagnosis of pulmonary edema in elderly patients, but also has some limitations.