CT对肺爆炸冲击伤伤情特征分析和伤情严重程度评估价值研究  

CT scan in the characteristic analysis and injury severity evaluation of pulmonary explosion blast injury

作　　者：封玲 王瀚苇 曾琳岚 李轩 刘美金 段朝霞 王建民 王舒楠 Feng Ling;Wang Hanwei;Zeng Linlan;Li Xuan;Liu Meijin;Duan Zhaoxia;Wang Jianmin;Wang Shunan(Department of Radiology,Daping Hospital,Army Medical University,Chongqing Clinical Research Center for Imaging Medicine and Nuclear Medicine,Chongqing 400042,China;Department 6,Research Institute of Field Surgery,Daping Hospital,Army Medical University,Chongqing,400042 China)

机构地区：[1]陆军军医大学大坪医院放射诊断科、重庆市影像医学与核医学临床研究中心,重庆400042 [2]陆军军医大学大坪医院野战外科研究部第六研究室,重庆400042

出　　处：《创伤外科杂志》2025年第4期246-253,共8页Journal of Traumatic Surgery

基　　金：重庆市科卫联合医学科研项目(2025QNXM014);陆军军医大学教育改革研究课题(2022A14);陆军军医大学科技创新能力提升专项项目(2023XLC15)。

摘　　要：目的 建立肺爆炸冲击伤试验羊外场实爆模型,分析肺部伤情的CT影像学特征,并评估CT对伤情严重程度的预测价值。方法 选取87只健康羊,右侧朝爆心自然站立,距爆心3、4、5m扇形布放,采用8kg三硝基甲苯(TNT)当量裸药柱,分批进行冲击波致伤。采用车载16排CT于伤后1 h内进行数据采集,观察羊一般情况并进行肺大体解剖。根据病理评分将受伤山羊分为轻度组(n=16)、中度组(n=17)、重度组(n=28)和极重度组(n=10)。采用描述性研究方法分析肺冲击伤CT影像特征。采用CT半定量视觉评分法和损伤体积占比定量测量法分别对肺部伤情严重程度进行评估。绘制受试者操作特征(ROC)曲线评估CT相关参数对肺部伤情严重程度的预测价值。结果 肺内主要伤情特征为肺挫裂伤(71.2%)、气胸(17.2%)、肺不张/肺实变(17.2%)、肺气囊(14.9%)等,肺外合并伤情为胸椎骨折(31.0%)和皮下积气(18.3%)。CT半定量视觉评分结果显示,轻度组为(1.3±0.4)分、中度组为(4.8±0.4)分、重度组为(8.8±3.5)分、极重度组为(13.6±6.0)分,组间差异均有统计学意义(P均<0.01)。CT损伤体积占比定量测量结果显示,轻度组为0.04±0.02、中度组为0.25±0.03、重度组为0.42±0.13、极重度组为0.61±0.17,组间差异均有统计学意义(P均<0.01)。ROC曲线分析结果显示,CT半定量视觉评分预测不同肺损伤严重程度AUC分别为0.779(95%CI:0.881~0.947,轻度组vs.中度组)、0.841(95%CI:0.687~0.809,中度组vs.重度组)和0.800(95%CI:0.641~0.832,重度组vs.极重度组)。CT损伤体积占比定量测量预测不同肺损伤严重程度AUC分别为0.873(95%CI:0.882~0.952,轻度组vs.中度组)、0.832(95%CI:0.697~0.832,中度组vs.重度组)和0.850(95%CI:0.656~0.850,重度组vs.极重度组)。结论 肺爆炸冲击伤伤情复杂,表现多样,CT可以全面观察和诊断肺部伤情,且对评估肺爆炸冲击伤伤情严重程度有较高的诊断价值。Objective To analyze the imaging characteristics of pulmonary explosion blast injury and to evaluate the predictive value for injury severity by CT scan via a field-based live-explosion goat model.Methods Eighty-seven healthy goats were positioned in standing posture and located in a fan-shape,with their right side facing the explosion source at 3,4,and 5 m from the detonated charge.A single unencased TNT-equivalent explosive column(8 kg)was administered to induce blast injuries.Chest CT scans were conducted within 1 h post-injury using a mobile 16-row CT scanner.General observation and gross pulmonary anatomical examination were performed.Based on their pathological scores,goats were classified into four injury severity groups,respectively mild(n=16),moderate(n=17),severe(n=28),and extremely severe(n=10).Descriptive statistics were used to analyze the CT imaging characteristics.CT semi-quantitative visual scoring and quantitative measurement of injury volume ratio were employed to assess the injury severity.Receiver operating characteristic(ROC)curves were constructed to evaluate the predictive value of CT-related parameters for the severity of pulmonary blast injuries.Results The primary CT findings included pulmonary contusion/laceration(71.2%),pneumothorax(17.2%),atelectasis/consolidation(17.2%),and pulmonary bullae(14.9%),with associated extrapulmonary injuries such as thoracic vertebra fractures(31.0%)and subcutaneous emphysema(18.3%).CT semi-quantitative visual scoring showed significantly different scores among groups:mild(1.3±0.4),moderate(4.8±0.4),severe(8.8±3.5),and extremely severe(13.6±6.0)(P<0.01 for comparison between any two groups).Quantitative measurement of the injury volume ratio showed the same results:mild(0.04±0.02),moderate(0.25±0.03),severe(0.42±0.13),and extremely severe(0.61±0.17)(P<0.01 for comparison between any two groups).ROC curve analysis indicated that the AUC to predict blast injury severity using CT semi-quantitative visual scoring was 0.779(95%CI:0.881-0.947,mild vs.mo

关 键 词：爆炸伤 肺冲击伤 CT 动物模型 伤情严重程度 

分 类 号：R642[医药卫生—外科学] R445.3[医药卫生—临床医学]