HRCT对急性百草枯中毒肺损伤的影像与临床评价

Radiographic and Clinical Evaluation of HRCT on Paraquat-induced Pulmonary Damage

目的:探讨胸部HRCT对百草枯中毒肺损伤的影像特征及临床意义。方法:回顾性分析13例百草枯中毒患者的胸部影像学资料,结合临床,总结胸部HRCT在百草枯中毒肺损伤中的影像特征及诊断价值。结果:13例中8例存活3周以上的患者,中毒早期(≤2 d)5例表现为过度通气、磨玻璃影。1例两下肺小片状实变。1例仅见双侧少量胸腔积液,2例无明显异常。中期(3d～21d)显示弥漫磨玻璃密度影分布7例,渗出病变6例,实变5例。肺气肿5例。纵隔积气1例。晚期(>3周)8例表现不同程度肺间质纤维化和肺小蜂窝改变,2例伴牵引性支气管扩张。5例死亡病例中早期即表现为渗出性病变和肺实变为主。结论:胸部HRCT检查对百草枯中毒肺损伤的影像特征和进展分析有明显优势,在指导临床治疗和预后评价方面有重要意义。

Objective To investigate the HRCT feature and clinic significance of paraquat-induced pulmonary damage. Methods The chest radiographic data of 13 patients with paraquat poisoning were reviewed retrospectively; combined with clinic and summarized the chest HRCT feature and diagnostic value. Results 8 patients of 13 survived over 3 weeks. In the early period（ ≤2 days） ,in 5 of them,the predominate findings were hyperventilation and glass density; 1 case combined with small patchy consolidation in both lungs ; 2 cases of little hydrothorax ; while the other 2 cases showed normal. In the middle period（3 - 21 days）, extensive glass density were found in 7 cases, exudation in 6 cases, consolidation in 5 cases, pulmonary emphysema in 5 cases with mediastinal emphysemain 1 case. In the late period（ 〉 3 weeks）, pulmonary firbrosis and microcyst formation in different degree were shown in all the 8 cases, 2 cases combined with bronchiectasis. The exudation and consolidation changes could be seen early in other 5 death cases. Conclusion Chest HRCT has great advantage in radiographic feature and progression of paraquat-induced pulmonary damage and has important significance in conduction of clinic therapy, evaluation of prognosis.