肺爆震伤的影像学表现

Imaging Features of Blast Lung Injury

目的 肺爆震伤病情重,临床救治困难,是爆炸现场死亡的主要原因。本研究探讨肺爆震伤的影像学表现,为临床诊断及治疗提供参考。资料与方法 回顾性总结2014年“8.2”昆山爆炸事件引起的37例肺爆震伤患者的烧伤程度、面积、既往病史、辅助急诊治疗等临床资料,分析患者的X线和（或）CT影像表现。结果1 37例患者胸部X线结合（或）CT检查结果显示：肺实质未见明显异常6例（16.2%）,肺纹理增粗并斑点状模糊影14例（37.8%）,毛玻璃样改变6例（16.2%）,肺段或肺叶性实变7例（18.9%）,弥漫性实变4例（10.8%）。合并胸腔积液6例（16.2%）,气胸、液气胸6例（16.2%）,心影增大（并心包积液）4例（10.8%）,纵隔血肿2例（5.4%）,肋骨骨折9例（24.3%）。X线平片检查阳性率为72.2%（13/18）,CT阳性率为92.9%（13/14）。2 5例急诊X线检查肺实质未见明显异常者第2~5天复查出现斑点状、点片状模糊影;9例临床症状加重且有感染征象者CT复查示征象明显加重,原发病灶呈扩大或融合状态。结论 影像学检查是诊断肺爆震伤的重要方法,CT检查在病变的检出及病灶范围上优于X线平片,建议此类患者在条件允许时尽早行胸部CT检查。

Purpose Blast lung injury is severe, and is the main causes of death in explosion. This paper aims to explore the imaging features of blast lung injury, and to provide reference for clinical diagnosis and care. Materials and Methods The clinical data of 37 patients with primary blast lung injury stricken in the ＂8.2＂ Kunshan explosion in 2014 were retrospectively studied, with regard to the degree of burn, area, auxiliary emergency treatment and medical history. The imaging manifestations of X-ray and/or CT were also analyzed. Results （2） The X-ray and/or CT findings of chest showed that 6 cases （16.2%） presented no obvious abnormality of lung parenchyma, 14 cases （37.8%） manifested increase of lung markings and spot-like clouding opacity, 6 cases （16.2%） presented ground glass opacity, 7 cases （18.9%） manifested patchy shadow, 4 cases （10.8%） showed diffuse consolidation. 6 cases （16.2%） with pleural effusion, 6 cases （16.2%） complicated with pneumothorax and hydropneumothorax, 4 cases （10.8%） with enlarged podoid and pericardial effusion, 2 cases （5.4%） with mediastinal hematoma, 9 cases （24.3%） with rib fracture. The positive rate of X-ray film inspection was 72.2% （13/18）, yet that of CT reached 92.9% （13/14）. （2） Five patients who had not been seen obvious abnormal in emergency lung examination appeared mottling shadows or flake fuzzy shadows in the examination on the second day; 9 cases with aggravated symptorns and infection signs displayed relieved signs, expanded or changed primary lesions. Conclusion Imaging examination is an important tool in the diagnosis of primary blast lung injury. CT is superior to X-ray film on the detection of lesions; therefore, CT examination on chest should be carried out as soon as possible if conditions are allowed.