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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 ;HRCT可在早期发现肺小叶水平变化
Objective To investigate the CT and HRCT manifestations and their pathological basis of pulmonary teleconnection in high altitude craniocerebral gunshot wounds. Methods 18 pigs were adapted to plateau, divided into experimental group (12 rats) and control group (6 rats). Domestic 5.80mm ballistic gun, resulting in pig right brain injury. Chest CT and HRCT scan, the production of inflatable fixed lung specimens, pathology and conventional biopsy. Stepwise contrast CT, HRCT, inflatable fixed lung specimens HRCT, pathology and conventional pathology of the corresponding sections of the biopsy. Results (1) CT showed lung, segment or sub-section consolidation; bronchial vascular bundle edge rough, fuzzy, peripheral lung field was ground glass-like changes; atelectasis. (2) HRCT see part of the lung lobular solidification, emphysema, ground glass-like changes; interlobular septa, lobular nuclear thickening, thickening. (3) The signs of HRCT scanning of live animals can be shown in the HRCT scans of inflatable fixed lung specimens. (4) large pathological see, alveolar cavity, bronchial tube wall space visible edema and red blood cells; sub-section atelectasis. (5) See the general pathological pulmonary microvascular dilatation and rupture. Alveolar septum, bronchioles rupture. Pulmonary interstitial and alveolar hemorrhage, and visible high-protein, hypertonic effusion edema. Conclusions Plateau craniocerebral gunshot wounds as far as the effect of lung injury caused by blood flow disturbance wave bleeding and exudation; injury can induce high altitude pulmonary edema; CT examination can be found bleeding exudation due to consolidation, atelectasis Pulmonary outreach more common; HRCT early detection of changes in lung lobe level