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目的:分析35例高原肺水肿的X线表现征象,讨论与不同发病时间及病理改变的关系和意义。方法:西藏昌都地区平均海拔高度3 500m,昌都邦达机场平均海拔高度4 600m。35例中除1例外籍人士外均为汉族,第一次急进高原23例,再次重返高原12例。乘飞机首次抵海拔4 600m高原后不久发病16例,而再次重返高原中有3例。结果:高原肺水肿早期(发病第1天)X线表现征象:以肺纹理增多似间质型纤维化或支气管炎样改变、小斑片影或似絮状影改变为主,以右肺中下叶改变多;进展期(第2天~3天)呈多样特点,如小斑片影似絮状影、斑片影似有融合样改变、片影如蝶翼样其典型为蝴蝶状分布于两肺、弥漫状实变影;稳定期与恢复期(第4天~5天)与早期似有一定类似,如以小斑片影或似絮状影改变,肺纹理增多似间质型纤维化与支气管炎样改变为主。结论:高原肺水肿系综合因素结果,除低氧刺激使肺泡壁内毛细管超微结构改变与神经、体液调节紊乱外,高寒低温、上呼吸道感染与休息不佳等均有明显关系,高原肺水肿的X线表现不但与发病的时间有明显关系,也与病理改变联系密切。
OBJECTIVE: To analyze the X-ray manifestations of 35 cases of high altitude pulmonary edema and discuss the relationship between them and the time of onset and the pathological changes. Methods: The average altitude of Changdu in Tibet is 3 500 m, and the average altitude of Qamdo Banda Airport is 4 600 m. Of the 35 cases, all but one foreigner were Han nationality. The first time, they were rapidly entering the plateau in 23 cases and returned to the plateau again in 12 cases. Sixteen cases were reported shortly after they arrived at the plateau of 4 600 m above sea level for the first time by plane, while three returned to the plateau again. Results: In the early stage of high altitude pulmonary edema (the first day of onset), the X-ray showed signs of pulmonary fibrosis: interstitial fibrosis or bronchitis-like changes, patchy or flocculent changes, Lower leaves change more; progressing (days 2 to 3 days) showed a variety of features, such as small patchy film like flocculent shadow patchy images seem to have a fusion-like changes, films such as butterfly-like butterfly is typical for its distribution In both lungs, diffuse real change; stable and recovery period (day 4 to 5 days) and early seems to be somewhat similar, such as small patchy or flocculent shadow changes, increased lung markings like interstitial Fibrosis and bronchitis-like changes. Conclusions: The results of the comprehensive factors of pulmonary edema in the plateau show that, in addition to hypoxia stimulation, alveolar wall capillary ultrastructural changes and neurological and humoral regulation disorders, alpine hypothermia, upper respiratory tract infection and poor rest have a significant relationship, high altitude pulmonary edema X-ray findings not only with the time of onset have a clear relationship, but also closely linked with pathological changes.