高原肺水肿的X线表现征象与发病时间和病理的关系

The Relationship Between X-ray Chest Image Appearances and Incidence Time of High Altitude Pulmonary Edema(HAPE)

目的：分析35例高原肺水肿的X线表现征象，讨论与不同发病时间及病理改变的关系和意义。方法：西藏昌都地区平均海拔高度3500m，昌都邦达机场平均海拔高度4600m。35例中除1例外籍人士外均为汉族，第一次急进高原23例，再次重返高原12例。乘飞机首次抵海拔4600m高原后不久发病16例，而再次重返高原中有3例。结果：高原肺水肿早期（发病第1天）X线表现征象：以肺纹理增多似间质型纤维化或支气管炎样改变、小斑片影或似絮状影改变为主，以右肺中下叶改变多；进展期（第2天-3天）呈多样特点，如小斑片影似絮状影、斑片影似有融合样改变、片影如蝶翼样其典型为蝴蝶状分布于两肺、弥漫状实变影；稳定期与恢复期（第4天-5天）与早期似有一定类似，如以小斑片影或似絮状影改变，肺纹理增多似间质型纤维化与支气管炎样改变为主。结论：高原肺水肿系综合因素结果，除低氧刺激使肺泡壁内毛细管超微结构改变与神经、体液调节紊乱外，高寒低温、上呼吸道感染与休息不佳等均有明显关系，高原肺水肿的X线表现不但与发病的时间有明显关系，也与病理改变联系密切。

objective： To investigate X - ray chest image appearances and its relationship with incidence and pathological changes in high altitude pulmonary edema patients. Methods： 35 objects, who were exposed acutely to Changdu （mean 3 500m altitudes）, 23 of 35 patients were exposed to high altitude in first time and 16 cases suffered the acute high altitude pulmonary edema （ HAPE）, and 3 cases with HAPE were in secondly exposed altitude group （n = 12, 12/35）. The radiography, ECG and some tests were examined in patients with HAPE. Results： The X- ray chest image appearances in early HAPE showed as follows： The lung marking and patchy shadow increase in peripheral lung field or the bronchitis kind change, especially in the right lung lobe. With the progress of HAPE x- ray chest film showed as present diverse characteristics, such as small spot, the spots have the fusion kind change, as a wing kind its typical model to distribute for the butterfly form in two lungs. Finally （ Stabilize and convalescent type） the feature chest film was as same as the earlier period of HAPE. Conclusions： There is a obvious relationship between the incidence time and x- ray chest image of acute HAPE.