高原颅脑枪弹伤肺部损伤远达效应CT及HRCT影像病理对照研究  

Lung Remote Effect of Craniocerebral Penetrating Wounds Caused at High Altitude:Comparative Study on HRCT and Pathology

作　　者：王玮[1] 陈辉武[2] 王劲武[2] 方向东[2] 陆洲[1] 刘洁[2] 刘斌[2] 赵耀[2] 

机构地区：[1]第四军医大学唐都医院放射科,陕西西安710038 [2]西藏军区总医院放射科

出　　处：《实用放射学杂志》2003年第11期966-970,共5页Journal of Practical Radiology

摘　　要：目的　探讨高原颅脑枪弹伤肺部远达效应的CT及HRCT表现及其病理基础。方法　高原适应猪 18只 ,分实验 (12只 )、对照 (6只 ) 2组。国产 5 .80mm弹道枪 ,造成猪右脑贯通伤。行胸部CT及HRCT扫描 ,制作充气固定肺标本、病理大切片和常规病理切片。逐级对照CT、HRCT、充气固定肺标本HRCT、病理大切片和常规病理切片相应表现。结果　 (1)CT示肺叶、段或亚段实变 ;支气管血管束边缘毛糙、模糊 ,周边肺野呈磨玻璃样改变 ;肺不张。 (2 )HRCT见部分肺小叶实变、气肿、磨玻璃样改变 ;小叶间隔、小叶核增厚 ,增粗。 (3 )活体动物HRCT扫描所见征象均可在充气固定肺标本的HRCT扫描中显示。 (4 )病理大切片见 ,肺泡腔、支气管血管束管壁间隙内可见水肿液和红细胞 ;亚段肺不张。 (5 )常规病理见肺微血管扩张、破裂。肺泡隔、细支气管断裂。肺间质和肺泡腔内出血 ,并可见高蛋白、高渗出性水肿液。结论　高原颅脑枪弹伤远达效应肺损伤以血流扰动波所致的出血、渗出为主 ;损伤可诱发高原肺水肿 ;CT检查可发现出血渗出所致的实变、不张 ,以肺外带多见 ;Objective To detect the HRCT imaging features and their pathological basis of lung's remote effects induced by craniocerbral penetrating wounds at high altitude.Methods Eighteen pigs acclimatized to high altitude were divided into 2 groups (experiment group 12, control group 6). Right craniocerbral penetrating wounds were made by 5.80 mm ballistic trajectory gun. Chest CT and HRCT scan were performed. Making manufacture inflation fixed lung samples. Lung's large histological slices and routine slices were made. The CT and HRCT scan images of pig thorax and lung samples were compared with the pathological changes of the large tissue slices and routine slices seriatim.Results (1) The CT scan images showed that lobe, segment or subsegment consolidation occurred in the pig's lungs and the edge of the lung bronchus-vessel bundle's images became fuzzy. The peripheral lung field became less transparent like ground glass. (2) HRCT scan images show that consolidation, emphysema or 'ground glass' like changes occurred in some lung lobules. The septa and centre of lobules were thickened. (3) The HRCT scan images in living body showed the same as that from the manufacture inflation fixed lung samples. (4) Lung slices showed that the pulmonary alveoli were filled with erythrocytes and serous extravasate,and subsegment atelectasis. (5) Lung blood capillaries dilated and rhexis occurred. Hemorrhage and edema can be observed in interstitial and lung alveoli. Some of the septa and the walls of vessels became loosened. Serous extravasate and small amount of inflammataory cells can be observed in the interstitial and alveoli.Conclusion The lung's remote effects induced by craniocerbral penetrating wounds at high altitude are characterized by hemorrhage and exudation which are induced by the disturbed blood hydrokinetic waves. CT scan is helpful in detecting pulmonary atelectasis and consolidation induced by hemorrhage and exudation. HRCT scan can detect the pathologic changed of lung lobule in early stage.

关 键 词：高原 颅脑枪弹伤 肺部损伤 远达效应 CT HRCT 病理对照研究 

分 类 号：R651.15[医药卫生—外科学]