中国医学影像学杂志
中國醫學影像學雜誌
중국의학영상학잡지
CHINESE JOURNAL OF MEDICAL IMAGING
2015年
6期
458-460,465
,共4页
爆震伤%肺损伤%放射摄影术%体层摄影术,螺旋计算机
爆震傷%肺損傷%放射攝影術%體層攝影術,螺鏇計算機
폭진상%폐손상%방사섭영술%체층섭영술,라선계산궤
Blast injuries%Lung injury%Radiography%Tomography,spiral computed
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①37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）。②5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。
目的肺爆震傷病情重，臨床救治睏難，是爆炸現場死亡的主要原因。本研究探討肺爆震傷的影像學錶現，為臨床診斷及治療提供參攷。資料與方法迴顧性總結2014年“8.2”昆山爆炸事件引起的37例肺爆震傷患者的燒傷程度、麵積、既往病史、輔助急診治療等臨床資料，分析患者的 X 線和（或）CT 影像錶現。結果①37例患者胸部 X 線結閤（或）CT 檢查結果顯示：肺實質未見明顯異常6例（16.2%），肺紋理增粗併斑點狀模糊影14例（37.8%），毛玻璃樣改變6例（16.2%），肺段或肺葉性實變7例（18.9%），瀰漫性實變4例（10.8%）。閤併胸腔積液6例（16.2%），氣胸、液氣胸6例（16.2%），心影增大（併心包積液）4例（10.8%），縱隔血腫2例（5.4%），肋骨骨摺9例（24.3%）。X 線平片檢查暘性率為72.2%（13/18），CT 暘性率為92.9%（13/14）。②5例急診 X 線檢查肺實質未見明顯異常者第2~5天複查齣現斑點狀、點片狀模糊影；9例臨床癥狀加重且有感染徵象者 CT 複查示徵象明顯加重，原髮病竈呈擴大或融閤狀態。結論影像學檢查是診斷肺爆震傷的重要方法， CT 檢查在病變的檢齣及病竈範圍上優于 X 線平片，建議此類患者在條件允許時儘早行胸部 CT 檢查。
목적폐폭진상병정중，림상구치곤난，시폭작현장사망적주요원인。본연구탐토폐폭진상적영상학표현，위림상진단급치료제공삼고。자료여방법회고성총결2014년“8.2”곤산폭작사건인기적37례폐폭진상환자적소상정도、면적、기왕병사、보조급진치료등림상자료，분석환자적 X 선화（혹）CT 영상표현。결과①37례환자흉부 X 선결합（혹）CT 검사결과현시：폐실질미견명현이상6례（16.2%），폐문리증조병반점상모호영14례（37.8%），모파리양개변6례（16.2%），폐단혹폐협성실변7례（18.9%），미만성실변4례（10.8%）。합병흉강적액6례（16.2%），기흉、액기흉6례（16.2%），심영증대（병심포적액）4례（10.8%），종격혈종2례（5.4%），륵골골절9례（24.3%）。X 선평편검사양성솔위72.2%（13/18），CT 양성솔위92.9%（13/14）。②5례급진 X 선검사폐실질미견명현이상자제2~5천복사출현반점상、점편상모호영；9례림상증상가중차유감염정상자 CT 복사시정상명현가중，원발병조정확대혹융합상태。결론영상학검사시진단폐폭진상적중요방법， CT 검사재병변적검출급병조범위상우우 X 선평편，건의차류환자재조건윤허시진조행흉부 CT 검사。
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 ① 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 symptoms 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.
