插管法0.9%生理盐水多层螺旋CT小肠造影的临床应用价值

发布时间：2019-04-19 17:33

【摘要】：目的：评价插管法灌注0.9%生理盐水多层螺旋CT小肠造影(multislice CT enterography, MSCTE)的可行性,并探讨插管法CT小肠造影在肠道疾病中的临床应用价值。方法：对2009年12月～2012年4月本院就诊病例29怀疑小肠疾病患者收入本组研究。插管法灌注0.9%的生理盐水溶液1500-2000ml,于扫描前30分钟内持续匀速全部灌完,一般为1500ml,个别根据患者的耐受性及患者体重情况适当增加500ml,以达到小肠各段充分扩张,在灌注造影剂20分钟时(即扫描前10分钟)肌注低张药物654-210mg,在生理盐水灌注完后即刻行全腹部CT平扫及增强扫描。对29例患者的小肠扩张程度数据分别进行统计。结果：(1).插管法多层螺旋CT小肠造影在29例患者中均成功完成了SCTE检查,除稍感腹胀外,均无明显不适感。(2).插管法0.9%生理盐水多层螺旋CT小肠造影能适度地扩张肠腔,29例患者中小肠平均充盈度评分为2.82分,空肠平均充盈度评分为2.5分,回肠的平均充盈度评分为2.75分。23例扩张度达3级,4例扩张度为2级,2例扩张度为1级。空肠扩张度平均为20.5±3.6mm,回肠扩张度平均为19.0±3.2mm,空、回肠肠管扩张度比较无统计学差异(P0.05)。(3).插管法多层螺旋CT小肠造影诊断小肠肿瘤5例,活动性Crohn’s病7例,肠结核2例,其它疾病1例,14例无异常发现(其中2例为假阴性)。(4).插管法多层螺旋CT小肠造影诊断肠道疾病的敏感性、特异性、准确性、阳性预测值及阴性预测值各自为88.2%,100%,93.1%,100%,85.7%。结论：(1).0.9%生理盐水其渗透压值和正常人的血浆、组织液大致一样,比较合乎生理情况,作为小肠CT阴性造影剂,能够很好的扩张小肠,且能很好的显示肠壁情况,可以作为有病变小肠的一种合理造影剂的选择,而不会加重病人的病情。(2).插管法多层螺旋CT小肠造影能很好的扩张小肠肠管,易于发现和显示肠道病变,具有较高的敏感性、特异性及准确性。
[Abstract]:Aim: to evaluate the feasibility of instillation of 0.9% saline multi-slice spiral CT enterography (multislice CT enterography, MSCTE) by catheterization and to evaluate the clinical application value of CT enterography in intestinal diseases. Methods: from December 2009 to April 2012, 29 patients with suspected small bowel disease were enrolled in this study. The 0.9% saline solution was infused with 0.9% saline solution with a continuous and uniform rate of 1500ml, usually 1500ml, within 30 minutes before the scan. According to the patient's tolerance and the patient's body weight, an appropriate increase of 500ml was achieved individually in order to achieve the full dilation of the small intestine segments in order to achieve the full expansion of each segment of the small intestine. The hypotension drug 654mg / 210mg was injected intramuscularly at 20 minutes after perfusion of contrast agent (i.e. 10 minutes before scanning). The whole abdomen CT plain scan and contrast enhanced scan were performed immediately after the perfusion of normal saline. The data of the degree of intestinal dilatation in 29 patients were statistically analyzed. Results: (1). Multi-slice spiral CT enterography was successfully performed in 29 patients with abdominal distension except for slight abdominal distension. (2). 0.9% 0.9% saline multi-slice spiral CT enterography can appropriately dilate the intestinal cavity. The average intestinal filling score of 29 patients was 2.82 points, and the average filling degree of jejunum was 2.5points. The average filling score of ileum was 2.75. 23 cases were expanded to 3 grade, 4 cases to 2 grade, and 2 cases to 1 grade. The average dilation degree of jejunum and ileum were 20.5 卤3.6mm and 19.0 卤3.2mm, respectively. There was no significant difference between empty and ileal dilation (P0.05). (- 3). There were 5 cases of small intestinal tumors, 7 cases of active Crohn's 's disease, 2 cases of intestinal tuberculosis, 1 case of other diseases and 14 cases without abnormal findings (2 of which were false negative). (4) by multi-slice spiral CT enterography. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 88.2%, 100%, 93.1%, 100%, 85.7%, respectively. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 88.2%, 100%, 93.1%, 100%, 85.7%, respectively. Conclusion: (1) 0.9% saline has the same osmotic pressure as the normal human plasma and tissue fluid, which is in accordance with physiological conditions. As a negative contrast agent of CT in small intestine, it can dilate the small intestine very well. It can be used as a reasonable contrast medium for the diseased small intestine without aggravating the patient's condition. (2). Multi-slice spiral CT enterography with catheterization can dilate the intestinal tract easily find and display intestinal lesions and have high sensitivity specificity and accuracy.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R816.5

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