高原肺水肿的早期影像检查及影像表现探讨  

Investigation of image examination and pulmonary image of high altitude pulmonary edema in early stage

作　　者：谭健[1] 郑必海[2] 刘斌[1] 李素芝[2] 王宇亮[2] 闫春城[2] 郑建保[3] 

机构地区：[1]西藏军区总医院医学影像科,拉萨850007 [2]西藏军区总医院高山病科,拉萨850007 [3]西藏军区总医院干部病房,拉萨850007

出　　处：《西南国防医药》2010年第5期529-532,共4页Medical Journal of National Defending Forces in Southwest China

基　　金：国家科技支撑计划课题(2009BAI85B05)

摘　　要：目的对高原肺水肿(high altitude pulmonary edema,HAPE)的早期影像学表现进行探讨,为HAPE的早期诊断寻找更为可靠的检查手段和依据。方法对482例经临床筛选出的高度疑似HAPE对象进行常规X线检查及CT扫描;对确诊为HAPE的病例,在治疗恢复过程中的肺部病变进行动态观察,分析HAPE病例的X线检查及CT扫描特点。结果 482例高度疑似HAPE对象中,确诊为HAPE142例。常规X线检查,142例HAPE患者中,47例(33.10%)发现肺部有明确改变,95例(66.90%)未发现明确改变;CT扫描,142例HAPE患者均存在水肿,且以肺间质异常为主。其中磨玻璃样改变61例(42.96%),小结节样影34例(23.94%),散在、孤立终末支气管肺泡水肿15例(10.56%),纤细网纹状影13例(9.15%),肺纹理增粗、增多12例(8.45%),大片状云絮样影7例(4.93%)。142例HAPE早期患者治疗过程中,CT扫描均能清楚地反应肺部病变的恢复情况,其中1例第11d再次复查病变仍呈少量磨玻璃样改变残留。结论 HAPE早期肺部病变以肺间质异常为主,此时常规X线检查容易漏诊,对于临床症状明显,而常规X线检查肺部未见明显异常的高度疑似HAPE病例,CT扫描具有重要诊断价值。Objective To explore the pulmonary image of high altitude pulmonary edema（HAPE）in early stage,and to find a more reliable method of the early diagnosis of HAPE.Methods 482 people suspected highly as HAPE through clinical screening received routine X-ray examination and CT scanning.Then the pulmonary lesions of those diagnosed finally as HAPE were observed during restoration process after treatment,and their X-ray and CT characteristics were analyzed.Results Among above 482 subjects,142 cases were diagnosed finally as HAPE.Among these 142 HAPE cases,routine X-ray examination demonstrated that 47 cases（33.1%）had obvious pulmonary changes and 95 cases without obvious pulmonary changes（66.9%）.CT scanning demonstrated that all of 142 HAPE cases had the edema and the main abnormal changes appeared in pulmonary interstitium.There were 61 cases（42.96%）with ground-glass-like changes,34 cases with small spot shade（23.94%）,15 cases with sporadic and single edema in terminal bronchovesicular（10.56%）,13 cases with slim and mesh shade（9.15%）,12 cases with the increase and thickening of pulmonary markings（8.45%）and 7 cases with large sheets of flocculent shadow（4.93%）.CT scanning could clearly show the recovery of pulmonary lesions in all of 142 early HAPE patients during treatment period.Little changes of frosted glass in one case still presented after treatment for 11 d.Conclusion The pulmonary lesions of early HAPE occur mainly in pulmonary interstitium,and routine X-ray examination is prone to cause misdiagnosis.To those highly suspected HAPE cases with obvious clinical symptoms but no evident abnormal finding by X-ray examination,CT scanning is of important diagnostic value.

关 键 词：高原肺水肿 早期诊断 X线检查 CT 

分 类 号：R594.3[医药卫生—内科学]