Аналіз стану респіраторної системи дітей з бронхолегеневою дисплазією, за допомогою спіральної комп’ютерної томографії

Abstract

Introduction. X-ray changes are considered additional criteria determining the presence and severity of bronchopulmonary dysplasia (BPD). Radiographic studies allow indirectly identify signs of hyperinflation fibrosis, reaction interstices, pleural and pericardial connections that can be important not only for diagnosis of the disease, but also to predict its course and determine predictors of an unfavourable outcome of the disease. Objective: improving the diagnosis of bronchopulmonary dysplasia by identifying radiological markers of disease by high-resolution computed tomography. Materials and Methods: The study involved 249 patients of which 206 patients (86,56 ± 0,02%) patients with bronchopulmonary dysplasia in remission period (study group) and 43 children (21,06 ± 2,92%), born prematurely had respiratory disorders in the early neonatal period, but formed BPD (comparison group). Results and discussion: According to the CT ratio diameter arteries and bronchi (arterio-bronchial factor ABF) in the main group of children was 1,21 ± 0,012. In the comparison group it was lower (0,98 ± 0,008; p = 0,00001). These data suggest that in children with bronchopulmonary dysplasia has been a major expansion of branches of the pulmonary artery, indirect evidence of pulmonary hypervolemia and pulmonary hypertension. Correlation with SpO2 value ABF in patients of group (r = -0,275; p <0,05) determined the effect of hypoxia on ABF and satisfactory pulmonary vascular response to lower SpO2 thereby assume the presence of reversible vasoconstriction lungs. Transpulmonary bands are identified more often in observable with bronchopulmonary dysplasia than in the comparison group (p ≤ 0,001). Thickening of interlobular walls manifested mainly in the anterior region of the lung pleura in a perpendicular line shadow length ≤ 5mm. In the study group thickening of interlobular walls correlated with the severity of disease (r = 0,280; p <0.05) and did not depend on the form of BPD (r = 0,074; p <0.05). The deformation of the walls of the bronchi detected in eight of the patients with bronchopulmonary dysplasia. Interlobular thickening phenomenon walls and deformation of the walls of the bronchi in the comparison group of children were found. Reduced lung density and increase the transparency of local areas of lung tissue type "air traps" are identified in patients who were born prematurely, had respiratory disorders in the early neonatal period, but not formed and bronchopulmonary dysplasia in patients with BPD. The data allowed to form a hypothesis about the long-term preservation emphysema in children undergoing neonatal respiratory distress syndrome in history and considered unreliable for the diagnosis of BPD isolated emphysema. Symptom "frosted glass" from our point of view, the most controversial. He observed with equal frequency in both groups (p> 0.05). It is known that the symptom of " frosted glass" sign of pulmonary interstitial inflammation but may be the first link in fibrosis transformation. Area "frosted glass" correlated with the severity of BPD, symptoms of dyspnea, tachypnea, cyanosis, and oxygen saturation. The data suggests the relationship area " frosted glass" installed on high-resolution computed tomography with decreased. Outcome. Radiographic markers of bronchopulmonary dysplasia were availability bands, deformation of the walls of the bronchi according to X-ray of the chest. These figures correlate with the theme BPD according VRKT lungs (reduction in areas, the sum of the front and posterior edges greater than 15, increased lung pattern for linear type, deformation of the walls of the bronchi). Prospects for further researches. We consider it important correlation between biomarkers of BPD, morphological features and X-ray changes, the study of radiographic changes in preschool and school age who have had a history of BPD.