Chest CT features are associated with poorer quality of life in acute lung injury survivors.
Chest CT features are associated with poorer quality of life in acute lung injury survivors.
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DOI：
10.1097/ccm.0b013e31826a5062
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发表时间：
2013-02
影响因子：
8.8
通讯作者：
Standiford TJ
中科院分区：
文献类型：
--
作者：
Burnham EL;Hyzy RC;Paine R 3rd;Coley C 2nd;Kelly AM;Quint LE;Lynch D;Janssen WJ;Moss M;Standiford TJ
尽管急性肺损伤（ALI）的死亡率降低，但对ALI幸存者长期身体功能的研究一直报告说，由于尚不完全清楚的原因，在恢复后数年内生活质量持续较差。我们试图确定肺功能障碍是否与ALI幸存者的功能损害独立相关，并确定高分辨率计算机断层扫描是否可用于预测其发展。ALI随机对照试验数据的二次分析。三个学术医疗中心的重症监护室。在诊断后14天和/或180天进行高分辨率计算机断层扫描的诊断为ALI的患者。没有。采用客观的放射学评分系统对ALI患者在第14天和第180天获得的胸部高分辨率计算机断层扫描图像进行量化。这些分数在单变量和多变量分析中与肺功能测试和180天时获得的生活质量调查数据相关。89例患者在第14天有可评价数据，47例在第180天有可评价数据。在180天时，网状组织的放射学评分增加与肺总容量、用力肺活量和一氧化碳弥散量降低相关（p值均<0.002）。肺功能障碍导致的生活质量下降与较高的放射学评分密切相关。此外，14天的放射学评分独立预测180天的生活质量较差，考虑到年龄、疾病严重程度、作为ALI风险因素的肺炎和机械通气时间的长短。在ALI的幸存者中，胸部高分辨率计算机断层扫描受累的增加与限制性生理和较差的健康相关生活质量相关，提示肺功能障碍是这些患者活动受限的潜在因素。
Despite decreasing mortality rates in acute lung injury (ALI), studies of long term physical function in ALI survivors have consistently reported poorer quality of life persisting years into recovery for reasons that are not completely understood. We sought to determine if pulmonary dysfunction is independently associated with functional impairment among ALI survivors, and to determine if high resolution computed tomography could be used to predict its development. Secondary analysis of data from a randomized controlled trial in ALI. Intensive care units at three academic medical centers. Patients diagnosed with ALI who had high resolution computed tomography scans performed at 14 and/or 180 days after diagnosis. None. An objective radiologic scoring system was used to quantify patterns present on chest high resolution computed tomography obtained at 14 and 180 days in patients with ALI. These scores were correlated in univariable and multivariable analyses with pulmonary function testing and quality of life survey data obtained at 180 days. Eighty-nine patients had evaluable data at day 14, and 47 at 180 days. At 180 days, increased radiologic scores for reticulation were associated with a decreased total lung capacity, forced vital capacity, and diffusing capacity for carbon monoxide (p values all <0.002). Decrements in quality of life attributable to pulmonary dysfunction were most strongly associated with higher radiologic scores. Additionally, radiologic scores at 14 days independently predicted poorer quality of life at 180 days, accounting for age, severity of illness, pneumonia as the ALI risk factor, and length of time on mechanical ventilation. Among survivors of ALI, increasing chest high resolution computed tomography involvement correlated with restrictive physiology and poorer health related quality of life, implicating pulmonary dysfunction as a potential contributor to activity limitation in these patients.