百草枯中毒存活患者肺部HRCT影像学与肺功能动态变化  

Dynamic changes of pulmonary HRCT imaging and lung function of survival paraquat poisoned patients

作　　者：宋成珍[1,2] 菅向东[1] 

机构地区：[1]山东大学齐鲁医院急诊科中毒与职业病科,山东济南250012 [2]济南市急救中心,山东济南250021

出　　处：《中国工业医学杂志》2016年第2期95-98,共4页Chinese Journal of Industrial Medicine

摘　　要：目的回顾性分析口服百草枯中毒存活患者的临床资料及肺HRCT和肺功能的变化,探讨百草枯中毒患者不同时期肺部损伤情况及对临床意义。方法在2013年1月至2014年1月我科收治的急性口服百草枯中毒存活患者中,选取符合标准的病例37例,将患者分为轻度中毒组和中重度中毒组,重点分析各组患者中毒后第1天、3天、7天、14天、21天、8周、20周肺部HRCT影像学检查,中毒后3周、8周、20周肺功能及相应体力负荷耐受情况。结果急性百草枯中毒患者的肺HRCT影像学表现主要为渗出、纤维化、胸腔积液、气胸、胸膜肥厚、肺间质病变等,部分病例伴有心包膜肥厚、心包积液;轻度中毒患者发病至远期恢复,肺HRCT影像学均无明显变化;中重度中毒患者,渗出性病变、胸膜肥厚、纤维样变的远期与早期、中期、后期比较均P<0.05,胸腔积液远期与早期、中期比较P<0.05,间质病变中期与早期、后期、远期比较P<0.05,早期与后期比较P>0.05。轻度中毒组与中重度中毒组肺功能异常率比较P<0.05;中重度中毒组患者FEV1.0/FVC%、TLCOSB、VC、TLC、FVC、FEV1.0等指标与轻度中毒组患者比较,均P<0.05。结论重度百草枯中毒存活患者肺HRCT呈现动态变化;肺功能障碍以通气障碍为主,少数患者存在肺弥散功能障碍。肺功能的异常随着时间的延长、肺HRCT的好转而好转。Objective To explore the detail situation in pulmonry injury at different periods of paraquat poisoning and their elinieal signifieanee by retrospeetive analysis on elinieal information and dynamie ehanges of pulmonary HRCT imaging and lung function. Methods 37 patients of paraquat poisoning admitted in Shandong University Qilu Hospital from January 2013 to January 2014 were enrolled as study objects, elinical information including laboratory tests results during adimission were colleeted. The patients were divided into mild and severve groups, their pulmonary HRCT imagings at 1, 3, 7, 14, 21 days, 8 weeks and 20 weeks after hospitalization, and pulmonary function even corresponding physical load toleranee situation at 21 days, 8 weeks and 20 weeks were all analyzed. Results The results showed that the main characteristic of pulmonary HRCT imagings in paraquat poisoned patients were exudation, fibrosis, pleural effusion, pneumothorax, pleural thiekening, interstitial lung damage, etc. There is no obvious ehange in HRCT imaging manifestations in mild group, but there were some significant differenee in the imaging changes mentioned above with the periods of illness. The abnormal rate of pulmonary ruction had signifieant differenee （P〈0. 05） between mild and severe groups and the values of FEV10/FVC %, TLcoSB, VC, TLC, FVC, FEV1.0 between mild and severe groups were also signifieantly different （P〈0. 05 ）. Conclusion Severe paraquat poisoning patients had dynamie ehanges in lung HRCT ; the lung manifested mainly as ventilation dysfunction, a few patients also showed pulmonary diffuse dysfunetion, and pulminary function might get better with time and improvement of pulmonry HRCT imagings.

关 键 词：百草枯中毒 肺损伤 肺HRCT 肺功能 随访 

分 类 号：R595.4[医药卫生—内科学]