口服百草枯致中毒性肺损伤治疗过程中CT征象演变  

The pulmonary CT sign variation during treatment process of the patients with oral toxicity of paraquat

作　　者：朱蔚[1] 王浩初[2] 金文扬[1] 朱海勇[1] 秦杰[1] 孙翔[1] 

机构地区：[1]浙江省台州医院急诊科,浙江临海317000 [2]浙江省台州医院放射科,浙江临海317000

出　　处：《医学影像学杂志》2012年第3期382-385,共4页Journal of Medical Imaging

摘　　要：目的探讨口服百草枯致中毒性肺损伤在治疗过程中CT征象演变特点及在疗效评估中的价值。方法回顾性对比分析23例口服百草枯中毒患者,按病程分为1周、2～3周及3周后(长期);按中毒剂量分为低剂量(<20mg/kg)、中等剂量(20～40mg/kg)和大剂量(>40mg/kg)3组;按肺部CT征象进行分型,分为1型(胸部阴性)、2型(肺部渗出为主)、3型(出现肺部实变或不张)、4型(出现肺纤维化病变),均采取规范的治疗措施,进而观察百草枯中毒性肺损伤治疗过程中肺部CT征象的演变,比较三个剂量组在不同时期各型的差异。结果 1例在全部病程胸部表现为阴性;余22例在病程第1周22例CT表现均为2型,在病程第2～3周20例CT表现为3型,在病程3周后(长期)2例(2/22)CT表现为4型。肺部CT表现:低剂量组有1型1例(全部病程)、2型1例;中等剂量组2例肺部均出现2型及3型CT征象,1例出现4型CT征象;大剂量组19例肺部均出现2型及3型CT征象,2例出现4型CT征象。低剂量组:1周内表现为2型1例,全病程表现为1型1例;中剂量组:1周内表现为2型2例、2～3周内表现为3型2例、3周后表现为4型1例;大剂量组:1周内表现为2型19例、2～3周内表现为3型2例、3周后表现为4型1例。结论口服百草枯致中毒性肺损伤在治疗过程中CT征象演变有一定的特征性和规律性,在各个治疗窗口期可提供有价值的影像学信息,有效评估临床治疗效果。Objective To summarize the CT features of lungs injury and to explore their values in diagnoses and treatments of oral toxicity of paraquat.Methods 23 patients with lung injury caused by oral toxicity of paraquat were analyzed retrospectively and comparatively.These patients were divided into the following groups： 1 week,2~3 week or 3-week later group according to pathogenesis,low dose group（20 mg/kg）,medium dose group（20~40 mg/kg）,and large dose group（40 mg/kg） according toxic dose;type 1（negative findings）,type 2（mainly with effusion）,type 3（mainly with consolidation and atelectasis）,and type 4（occurrence of pulmonary fibrosis） according to CT findings of lungs;In these cases,normalized therapeutic measures,further observation of the pulmonary CT sign variation and comparison of differences among groups were carried out.Results Among the 23 cases,there was only 1 case that lung CT showed normal during the whole pathogenesis.In the remaining cases,22 showed with type 2 in the 1st week,20 showed with type 3 in the following 2~3 rd week,and 2 cases showed with type 4 in the 3 rd week later.In low dose group,1 case presented with type 1 and 1 case with type 2.In medium dose group,2 cases exhibited both type 2 and type 3 and 1 case type 4.In large dose group,19 cases were concordant with both type 2 and type 3 and 2 cases with type 4.In low dose group,1 case presented with type 2 occurring within 1 week and 1 case with type 1 during the whole pathogenesis.In medium dose group,2 cases presented with type 2 occurring within 1 week,2 cases with type 3 occurring within 2~3 weeks,and 1 case with type 4 occurring 3 weeks later.In large dose group,19 cases presented with type 2 occurring within 1 week,2 cases with type 3 occurring within 2~3 weeks,and 1 case with type 4 occurring 3 weeks later.Conclusion There are some features and regularity in CT signs and their variation of pulmonary injury caused by oral toxicity of paraquat during treatment process,which can provide some valuable imaging

关 键 词：百草枯 中毒 肺损伤 体层摄影术 X线计算机 

分 类 号：R595.4[医药卫生—内科学] R814.42[医药卫生—临床医学]