多層螺旋ct畢業(yè)論文.doc

多層螺旋CT在肺撕裂傷中的表現(xiàn)及其應(yīng)用價(jià)值摘要你好： 審核發(fā)現(xiàn)，部分是抄襲博士或碩士，別人發(fā)表論文的長篇章節(jié)，表，圖。格式不符合要求，研究方向，分類號(hào)不正確。表格不是三線表。前言太多，統(tǒng)計(jì)有誤。討論和前言及綜述重復(fù)太多。近5年參考文獻(xiàn)太少，英文文獻(xiàn)太少。請(qǐng)修改。4月3日交醫(yī)學(xué)院。 麻煩讓抓緊修改，不要在敷衍我了，以前說好自己寫的，可是這都是摘抄網(wǎng)上的。 背景 隨著社會(huì)信息化和現(xiàn)代化的不斷發(fā)展，醫(yī)學(xué)技術(shù)的不斷深入研究在社會(huì)中的地位和作用也越來越重要。醫(yī)學(xué)科技的數(shù)字化、可視化為臨床信息的讀取和存取提供了極大的便利性，同時(shí)，也顯著提高信息讀取、存取的效率和準(zhǔn)確性。此外，隨著中國人口的不斷激增，各種交通意外事故的頻發(fā)駭人聽聞，所導(dǎo)致的嚴(yán)重后果如胸部創(chuàng)傷、頭顱創(chuàng)傷等在醫(yī)院急診病例中亦非常常見。肺撕裂傷患者需要CT及時(shí)診斷并進(jìn)行肺胸膜破裂口的修補(bǔ)，如果不夠及時(shí)準(zhǔn)確的判斷，將嚴(yán)重危及患者的生命安全。探索多層螺旋CT在肺撕裂傷中的表現(xiàn)及其應(yīng)用價(jià)值，旨在提高CT動(dòng)態(tài)觀察病情變化的準(zhǔn)確認(rèn)識(shí)，更好地完善醫(yī)療診斷技術(shù)，降低患者的死亡率。目的 研究分析多層CT掃描技術(shù)應(yīng)用于肺撕裂傷中的臨床表現(xiàn)及其應(yīng)用價(jià)值的探討。1. 探討高分辨計(jì)算機(jī)多體層的掃描(multi-slice spiral computed tomography, MSCT)圖像在顯示肺撕裂傷、氣道及胸膜變化的問題上對(duì)肺組織觀數(shù)據(jù)與臨床診斷結(jié)合的分析。2. 深入總結(jié)多層螺旋CT技術(shù)的應(yīng)用，使得臨床上對(duì)于肺撕裂傷患者可獲得形態(tài)學(xué)詳細(xì)描述 3.通過比較多層螺旋CT技術(shù)與X線平片、MRI、CT等如今臨床醫(yī)學(xué)上常用的醫(yī)學(xué)影像學(xué)手段之間的相同點(diǎn)和不同點(diǎn)，從而更加形象具體的探討分析多層CT掃描技術(shù)應(yīng)用于肺撕裂傷中的臨床表現(xiàn)及其應(yīng)用價(jià)值。方法 選擇2014年6月份我院收治的60例外傷患者為研究對(duì)象，均對(duì)其使用多層CT機(jī)進(jìn)行胸部平掃，觀察并記錄所有患者的病變情況。然后1）對(duì)研究患者CT處理數(shù)據(jù)進(jìn)行分析，了解肺撕裂傷、氣道及胸膜變化的問題上確立了主導(dǎo)地位，同時(shí)經(jīng)過科學(xué)系統(tǒng)化的數(shù)據(jù)處理后，減少人為的主觀干預(yù)，對(duì)患者不同程度肺撕裂傷進(jìn)行定性定量的分析診斷。2）利用科學(xué)的表面遮蓋顯示(surface shaded display，SSD)技術(shù)對(duì)所有研究患者進(jìn)行三維立體肺部（three-dimensional lung model，3D-lung)建模，并根據(jù)研究需要對(duì)其進(jìn)行手工切除校正。3）討論VRT作為立體圖像的代表，能夠進(jìn)行任何方位的旋轉(zhuǎn)觀察同時(shí)與MIP技術(shù)的聯(lián)合應(yīng)用比較，效果更加直觀清晰的展現(xiàn)出患者的狀況，而MPR技術(shù)則是將對(duì)患者的病情的透射性結(jié)果，特別是當(dāng)中的一些細(xì)節(jié)性的問題，使得對(duì)患者的診斷結(jié)果判定的可信度提高分析。結(jié)果：1）CT表現(xiàn)：所有受測患者當(dāng)中，共發(fā)現(xiàn)肺氣腫患者15例，病灶35個(gè)，其中扁形病灶15個(gè)，圓形或橢圓形的病灶15個(gè)，囊腫壁厚薄不均勻的病灶3個(gè)，囊腫壁薄而均勻的病灶2個(gè)，囊腫壁周圍都有片狀的磨砂玻璃樣陰影，氣腫大小在3-28mm。其次在圖像中可清晰的看出有一定程度的肺氣液囊腫，在所有的患者CT圖像觀察中分析，肺氣液囊腫患者共有25例，發(fā)現(xiàn)病灶部位65個(gè)，都可以明顯的看出有氣液平，且肺氣液囊內(nèi)的液體數(shù)量不等，其中呈弧形病灶30個(gè)，呈裂隙樣病灶5個(gè)，表現(xiàn)成圓形或橢圓形的病灶30個(gè)。針對(duì)肺血腫患者的圖像，患者中共有15例出現(xiàn)肺血腫現(xiàn)象，一共發(fā)現(xiàn)病灶15個(gè)，其形態(tài)表現(xiàn)主要為橢圓形，且血腫邊界較清晰，大小在40-5-HU。其余的5例患者呈現(xiàn)蜂窩樣改變，表現(xiàn)出低密度的蜂窩樣陰影，內(nèi)有許多小圓形的、裂隙樣的氣影，邊界模糊不清。結(jié)論：通過多層螺旋CT技術(shù)，可以清晰地觀察到患者的肺部組織內(nèi)的空腔的大小、分布、形態(tài)及其演變的變化規(guī)律，對(duì)于肺撕裂傷患者而言，診斷時(shí)快速有效，復(fù)查時(shí)，可以避免漏診或誤診，安心放心。且多層螺旋CT在早期的診斷中，多層螺旋CT應(yīng)用于臨床檢查或診斷，效果極具參考價(jià)值，值得推廣使用?！娟P(guān)鍵詞】多層螺旋CT；肺撕裂傷；肺氣囊腫；應(yīng)用價(jià)值英文部分等稿子定下來后再進(jìn)行最后的修改。 暫未做修改Performance and application value of multi-slice spiral CT in pulmonary laceration ofAbstractObjective To explore the research and analysis of multilayer CT scan technology in pulmonary laceration in the clinical manifestation and its application value. Discussion on high resolution computer multi body layer scanning (multi-slice spiral computed tomography, MSCT) analysis of the image in the display of pulmonary laceration, airway and pleural changes on the question of lung tissue and clinical diagnosis of leisure view data binding. Application and in-depth summary of multi-slice spiral CT technology, makes the patients with pulmonary laceration patients can obtain morphology described in detail, whether can be observed in patients with early secondary infection of lung surface, caused by pulmonary interstitial and pleural changes? Get detailed information on patients with early lung function status whether can quantitatively in clinical diagnosis?By comparing the same points between multi-slice spiral CT and X-ray plain film, MRI technology, CT is now commonly used clinical medicine medical imaging teaching means and different point, analysis and discussion of multislice CT scanning technology in the application of pulmonary laceration in the clinical manifestation and its value of application specific and thus more image, including the problems of its combination magazine reported at home and abroad were introduced, further complement the results of this study, to make the test results more persuasive.Methods 60 cases of traumatic patients in our hospital from 2014 to June as the research object, on the use of multilayer CT chest scan, observe and record the lesions in all patients. Then 1) of study on CT in patients with treatment of data for analysis, understanding the laceration of the lung, airway and pleural change issue to establish a dominant position, at the same time, through scientific system of data processing, greatly reduced the effect of subjective human intervention on the patients with different degree, pulmonary laceration by qualitative and quantitative analysis method to diagnose better. 2) shaded display using scientific surface (surface shaded display, SSD) for three-dimensional lung for all study patients Technology (three-dimensional lung model, 3D-lung) modeling, and research needs to carry on the manual correction according to resection. Observation of the three-dimensional model, research, analysis.The combined application of processing technology of CT scanning technology, including CPR, VRT, after MPR and MIP in the multi technology, describes the CPR technology can rib imaging bending in a plane to said, for patients suffered form does not obviously occult fracture shows more intuitive performance, discuss VRT as a representative of the stereo image, combination of rotating observation can be obtained at any range at the same time with MIP technology, the effect is more direct and clear to show the condition of patients, and the technique of MPR is to the patients condition of transmission of the results, especially some details of the problem, make the patients diagnosis results the determination of the reliability is improved analysis.Results: 1) CT showed: in all the patients, were found in 15 cases of patients with emphysema, and 35 lesions, 15 lesions of the flat, round or oval lesions in 15, cyst wall of uneven thickness of 3 lesions, cyst wall is thin and uniform 2 lesions, cyst wall all around the shadow frosted glass like sheet, emphysema size in 3-28mm. Then in the image can be clearly seen with lung cysts to some extent, the analysis in the patients with CT were observed in all of the images in lung liquid cyst patients, a total of 25 cases, the lesions were found in 65, can be seen clearly with air fluid level, and the number of lung sac inside the liquid range, which is in the shape of an arc lesions 30, a slit like 5 lesions showed round or oval, 30 lesions. According to the image of pulmonary hematoma patients, patients with a total of 15 cases of pulmonary hematoma phenomenon, found a total of 15 lesions, the morphological manifestations were oval, and hematoma boundary is clear, size in 40-5-HU. The remaining 5 cases patients showed honeycombing, showed a honeycomb like shadow of low density, air in the shadow of many small round, slit like, blurred boundary.2) the application value and significance: the application of multi-slice spiral CT technology, makes the patients with pulmonary laceration patients can obtain a detailed description of the external morphology, can be observed in patients with early secondary infection of lung surface, caused by pulmonary interstitial and pleural changes, get detailed information on patients with early pulmonary function can be quantitatively in clinical diagnosis the. Clinical observation of the patients with mild pulmonary laceration of lung damage, because of its very slight changes, lesions of X ray imaging without specific differences in check, at the same time symptoms and chest X-ray worsening of patients may be accompanied by the inspection results show different degree was a certain parallel relationship.The combined application of processing technology of CT scanning technology, including CPR, VRT, after MPR and MIP multi technology, CPR technology in rib imaging bending in a plane, for patients suffered form does not obviously occult fracture show more intuitive, VRT as the representative of stereo images, rotating observation can be obtained at any range, and combined application with MIP technology, the effect is more direct and clear to show the condition of patients, and the technique of MPR is to the patients condition of transmission of the results, especially some of the details of the problem, which makes the patients diagnosis result to determine the reliability is improved. In order for the patients in the presence of early pulmonary laceration and change the localized pulmonary laceration, can significantly improve the detection rate of patients with pulmonary trauma. Multislice spiral CT in clinical diagnosis and dynamic observation of pulmonary laceration best examination method, has the important guiding value in clinical treatment.3) 3D reconstruction image display, image three dimensional surface reconstruction of 60 patients showed pulmonary tissue of both sides is not smooth, the lack of full. Rotate through multi multi angle to it, can be very intuitive found with radian diaphragm and apex in the lung surface occurs. At the same time in the 3D reconstruction image in individual patients can be seen on certain points and cord like shadows, scattered punctate shadow and groove back and groove. In the use of computer technology for acquisition and processing of data at the same time, and later on referred to as processing technology for medical imaging processing technology. Image analysis including image description and image segmentation, image description, simply have a basic knowledge of the image, and according to the different characteristics and the relationship between different image description, so before analysis to deal with all the image segmentation. Including the different images of liberal arts, color, gray statistical characteristics, such as the distinction between different tissues or organs, after the image segmentation process after the many changes in the area of lesion changes and compared with the normal tissue, which can in multi-directional, multi angle more intuitive display effect. At present the most clinically commonly used two kind of display technology are surface reproduction (surface rendering, SR) and volume rendering (volume rendering, VR), commonly used SR technology as a kind of SSD post processing. In the observation of Figure 2, showing a small shadow is very important for the diagnosis, at present mainly relies on the High KV chest is defined, its deep roots and overlapping and resolution under caused judgment is not accurate, the observation shows that, in the three-dimensional surface reconstruction image of the patient shows, the visceral pleura and diaphragm, apex muscle surface not smooth, suggesting that is caused by certain large consequences of pulmonary laceration, although there was no serious stretching deformation change, but the small punctate spots have been in local distribution, not related to the whole lung, a more stable state.Conclusion: Clinical on pulmonary laceration mild patients, need to adopt some relatively higher sensitivity means or diagnostic measures, and to further improve the patients with mild pulmonary laceration of the inspection effect, can take the necessary intervention or timely treatment measures, never stable condition of the patient, to prevent secondary infection to prevent the further development of the disease, improve the quality of life of patients and health. General pulmonary laceration were associated with different degree of pulmonary contusion and injury of chest injuries to some extent, is of great significance for the differential diagnosis of clinical medicine. At the same time in the diagnosis and treatment for patients at the same time, should be closely combined with the conditions of patients with a history of trauma, and the clinical features of dynamic observation of absorption analysis. Multi slice spiral CT technique is a simple, comprehensive and strong, can be an image repeated operation, convenient and practical medical examination method, this technique is also the modern clinical medicine major hospitals to check pulmonary laceration patients an important diagnostic methods, by multi-slice spiral CT technology, can clearly observe the to the cavity in patients with lung tissue within the size, distribution, morphology and its evolution law of change, for pulmonary laceration patients, rapid and effective diagnosis, follow-up time, can avoid misdiagnosis, peace of mind at ease. And multi-slice spiral CT in the early diagnosis of chest, relative to the comparison group, can detect the air bag or slit image containing a circular or oval accurate, multi-slice spiral CT in clinical examination or diagnosis, effect of great reference value, it is worth to promote the use of.In the future, image navigation technology will be closely linked with the clinical, combined, the most obvious progress is the 3D image and two-dimensional X-ray techniques perfect if achieved, will be an important breakthrough in the clinical history, namely through image combined positioning technology, matching data and CT images of the data in the operation phase, also X-ray CT imaging technology can establish the operation through the C arm with a center, image navigation will believe in surgical trauma has extensive application.keyword multislice spiral CT; pulmonary laceration; lung cyst; application value前言1987年，西門子公司研制并推出了世界上第一臺(tái)螺旋CT1，連續(xù)螺旋掃描的方式開啟了醫(yī)學(xué)領(lǐng)域新的時(shí)代。1998年，在醫(yī)學(xué)技術(shù)人員的不斷努力下，在單螺旋、雙螺旋的基礎(chǔ)上推出了多層螺旋CT（MSCT，Multi-slice CT），將CT技術(shù)的發(fā)展又推向了一個(gè)新的水平2。多層CT采用錐形X線束，多排探測器，可以連續(xù)旋轉(zhuǎn)進(jìn)行掃描且旋轉(zhuǎn)一周可獲得多層圖像，大大提高了臨床影像掃描的速度，旋轉(zhuǎn)一周的掃描時(shí)間可短至0.5秒。由于多層螺旋CT能快速容積掃描，可以在短時(shí)間內(nèi)對(duì)患者身體的大范圍進(jìn)行持續(xù)性的數(shù)據(jù)信息采集，然后通過計(jì)算機(jī)的科學(xué)處理，就能獲得一層由多種技術(shù)綜合形成的僅有0.75mm的圖像3。肺撕裂傷是由胸部閉合性創(chuàng)傷引起的肺組織損傷，輕度的患者表現(xiàn)和肺挫傷大致相同，一般不易診斷發(fā)現(xiàn)6。重度的患者表現(xiàn)出肺組織破裂形成囊腫，且囊腫內(nèi)有積液或氣體7，更嚴(yán)重的則會(huì)形成血腫，同時(shí)如果伴有胸膜撕裂（血液和空氣進(jìn)入胸膜腔），就會(huì)導(dǎo)致血?dú)庑?。臨床上患者常見胸痛、咯血8，有的患者甚至發(fā)生昏迷、休克。研究發(fā)現(xiàn)，肺血腫的發(fā)生可為單個(gè)過多個(gè)，在患者沒有繼發(fā)性感染的情況下，血腫會(huì)隨著時(shí)間不斷被自身吸收，短則數(shù)周至數(shù)月，但其完全消退可能需要半年或一年的時(shí)間，血腫在消退后可留下少許線條狀疤痕?，F(xiàn)在臨床上針對(duì)于肺撕裂傷的診斷需要與患者的肺內(nèi)炎性病變的檢測進(jìn)行鑒別分析，如果患者有非常明確的創(chuàng)傷史，特別是在患者受創(chuàng)時(shí)發(fā)生的昏迷等癥狀，在對(duì)于肺撕裂傷患者的實(shí)際診療中發(fā)現(xiàn)9，必須與球形肺炎、肺部腫瘤以及肺囊腫等疾病進(jìn)行區(qū)別，在有創(chuàng)傷史的多發(fā)性肺血腫，多與肺氣囊腫或肺液氣囊腫相伴，并且一般的患者在短期復(fù)查時(shí)會(huì)出現(xiàn)縮小的情況，病灶部位周圍常見肺挫傷。至于臨床上比較嚴(yán)重的創(chuàng)傷性液氣囊腫在鑒別的同時(shí)需要仔細(xì)區(qū)分開與肺囊腫合并感染、空洞型肺癌、肺膿腫以及肺結(jié)核空洞等疾病，且患者的病灶部位多位于臨近胸膜處，另外，在對(duì)于創(chuàng)傷性肺氣囊腫的診斷鑒別中，則需要區(qū)分與肺囊腫、肺大泡的區(qū)別，通?；颊叻尾繒?huì)出現(xiàn)橢圓形或是長條狀的團(tuán)塊偽影，在明確外傷史及診斷治療后復(fù)查，無明顯改變。目前臨床上對(duì)于肺撕裂傷主要以X線胸片和多層螺旋CT為主要的診斷依據(jù)13，但X線胸片存在的分辨率低、前后重疊沒有立體感等缺點(diǎn)使得患者小陰影的顯現(xiàn)不明顯，給醫(yī)生患者帶來極大的不便14。多層螺旋CT技術(shù)的應(yīng)用，使得臨床上對(duì)于肺撕裂傷患者可獲得形態(tài)學(xué)詳細(xì)描述外，是否可以觀察患者早期繼發(fā)性感染引起的肺表面、肺間質(zhì)及胸膜的改變？15是否可以在臨床診斷中定量的獲得患者早期肺功能狀況的詳細(xì)信息？多層螺旋CT技術(shù)是一種簡便快捷、全面性強(qiáng)、可重復(fù)操作、方便實(shí)用的醫(yī)學(xué)上的一種影像學(xué)檢查方式16，這種技術(shù)也是現(xiàn)代臨床醫(yī)學(xué)上各大醫(yī)院檢查肺撕裂傷患者的一種重要的診斷方式，通過多層螺旋CT技術(shù)，可以清晰地觀察到患者的肺部組織內(nèi)的空腔的大小、分布、形態(tài)及其演變的變化規(guī)律，對(duì)于肺撕裂傷患者而言，診斷時(shí)快速有效，復(fù)查時(shí)，可以避免漏診或誤診，安心放心17。本課題選擇2014年6月份我院收治的60例外傷患者為研究對(duì)象，均對(duì)其使用多層CT機(jī)進(jìn)行胸部平掃，觀察并記錄所有患者的病變情況，并以此來進(jìn)一步研究分析多層CT掃描技術(shù)應(yīng)用于肺撕裂傷中的臨床表現(xiàn)及其應(yīng)用價(jià)值的探討。第一部分多層螺旋CT對(duì)肺撕裂研究對(duì)象的臨床表現(xiàn)研究臨床上常見的外傷中，胸部創(chuàng)傷已成為一種普遍創(chuàng)傷19，其中肺撕裂傷是胸部創(chuàng)傷的一種特殊表現(xiàn)疾病，醫(yī)學(xué)上通常通常采用CT診斷和動(dòng)態(tài)觀察來判斷患者受傷情況。目前，臨床上逐漸推廣使用的多層螺旋計(jì)算機(jī)體層掃描(multi-spiral computed tomography, MSCT)技術(shù)越來越多的運(yùn)用到肺撕裂傷患者的診斷分析中20，許多人針對(duì)于肺撕裂患者借助MSCT進(jìn)行觀察對(duì)象的診斷，僅僅只是作為一種有效于X線胸片的診斷輔助手段。在肺撕裂傷患者中局部的肺組織已經(jīng)開始發(fā)生一定程度的損害，為了能及時(shí)的對(duì)患者的病情做出合理有效的診斷，除了臨床上基本的根據(jù)患者的身體特征和表現(xiàn)癥狀以外，可以借助擁有強(qiáng)大的后處理功能的MSCT技術(shù)對(duì)患者進(jìn)行損害部位的定位及定量分析，詳細(xì)的了解到患者的肺組織的損害程度情況，這樣也就更加直觀的了解了患者肺表面以及內(nèi)部組織的病理性變化，從而為肺撕裂患者的早期治療提供更加客觀的診斷依據(jù)，并通過對(duì)研究數(shù)據(jù)的分析討論肺撕裂傷的CT表現(xiàn)特點(diǎn)21，并以此來加深對(duì)肺撕裂傷的認(rèn)識(shí)。1資料與方法1.1研究對(duì)象選擇2014年6月份我院收治的60例外傷患者為研究對(duì)象，其中男37例，女23例，年齡16-58歲，平均年齡（2612）歲，其中墜落傷患者22例，車禍傷患者26例，撞擊傷患者12例?；颊吲R床表現(xiàn)：大部分患者意識(shí)清醒，多為復(fù)合創(chuàng)傷；小數(shù)患者出現(xiàn)意識(shí)不清、失血性休克及呼吸困難等，多為高空墜落或車禍造成；無嚴(yán)重患者出現(xiàn)死亡情況。所以患者為均在2h內(nèi)進(jìn)行對(duì)其使用多層CT機(jī)進(jìn)行胸部平掃，觀察并記錄所有患者的病變情況。根據(jù)臨床治療后，36例患者進(jìn)行CT復(fù)查，32例患者進(jìn)行X線復(fù)查。排除標(biāo)準(zhǔn)：有毒氣物質(zhì)接觸史，患有肺部影像學(xué)檢查診斷的疾病或接塵、非接塵引起的肺功能異常性疾病。1.2檢查方式及設(shè)備1）準(zhǔn)備工作實(shí)驗(yàn)前首先要做好患者在檢查前的準(zhǔn)備工作，操作人員要認(rèn)真仔細(xì)的查看試驗(yàn)中所用的配套設(shè)備和實(shí)驗(yàn)儀器是否正確，開機(jī)是否正常等，設(shè)備的參數(shù)設(shè)置一定要恰當(dāng)，順序一定要按實(shí)驗(yàn)要求的循序漸進(jìn)，以免在操過過程中耽擱時(shí)間造成對(duì)研究結(jié)果的影響，對(duì)試驗(yàn)中所用的設(shè)備、儀器以及患者、周圍環(huán)境進(jìn)行全方位的滅菌消毒，以免在過程中對(duì)患者的撕裂傷造成感染。最后注意檢查試驗(yàn)中所需的相關(guān)藥劑或藥品，比如水、造影劑等。2）研究的60例肺撕裂傷患者均采用仰臥位，雙手抱頭，運(yùn)用GE Brightspeed elite 16-SCT按照常規(guī)的從胸廓入口到劍突以下大約3橫指寬度的范圍進(jìn)行胸部掃描22，掃描參數(shù): 150mAs，120 kV ， 螺距1.375:1，矩陣512 X 512, DFOV=36.0 cm23,機(jī)架旋轉(zhuǎn)一周時(shí)間0.8 s,重建層厚度1.25 mm，重建間距1.25 mm，最終實(shí)現(xiàn)標(biāo)準(zhǔn)算法重建24。1.3統(tǒng)計(jì)學(xué)方法所有數(shù)據(jù)均應(yīng)用SPSS 17.0統(tǒng)計(jì)學(xué)軟件進(jìn)行處理。以P0.05則認(rèn)為數(shù)據(jù)有統(tǒng)計(jì)學(xué)意義。2結(jié)果2.1病灶部位統(tǒng)計(jì)本研究的60例患者均于創(chuàng)傷后0.5-2小時(shí)內(nèi)完成第一次CT掃描和薄層重建，CT結(jié)果顯示，病灶部位統(tǒng)計(jì)結(jié)果，左肺上葉患者35例，左肺下葉患者30例，右肺上葉患者25例，右肺下葉患者20例，右肺中葉患者20例。所有患者共發(fā)現(xiàn)130個(gè)病灶部位，其中肺中心區(qū)域46（35.4%）個(gè)，肺部周圍區(qū)域及胸膜下位置84（64.6%）個(gè)。病灶部位僅累計(jì)一個(gè)肺葉的患者有25（41.7%）例，累計(jì)兩個(gè)肺葉的患者有30(50%)例，累計(jì)三個(gè)及三個(gè)以上肺葉的患者5(8.3%)例。2.2CT表現(xiàn)肺組織的CT值是由肺內(nèi)的肺組織、血液、氣體的含量比決定的，因此使用專門的圖像處理的軟件來仔細(xì)評(píng)估CT圖像，觀察分析圖像結(jié)果，如圖1所示的為肺氣腫的圖像，在所有受測患者當(dāng)中，共發(fā)現(xiàn)肺氣腫患者15例，病灶35個(gè)，其中扁形病灶15個(gè)，圓形或橢圓形的病灶15個(gè)，囊腫壁厚薄不均勻的病灶3個(gè)，囊腫壁薄而均勻的病灶2個(gè)，囊腫壁周圍都有片狀的磨砂玻璃樣陰影，氣腫大小在3-28mm。在圖2 圖像中可清晰的看出有一定程度的肺氣液囊腫，在所有的患者CT圖像觀察中分析，肺氣液囊腫患者共有25例，發(fā)現(xiàn)病灶部位65個(gè)，都可以明顯的看出有氣液平，且肺氣液囊內(nèi)的液體數(shù)量不等，其中呈弧形病灶30個(gè)，呈裂隙樣病灶5個(gè)，表現(xiàn)成圓形或橢圓形的病灶30個(gè)。圖3表現(xiàn)的是肺血腫患者的圖像，患者中共有15例出現(xiàn)肺血腫現(xiàn)象，一共發(fā)現(xiàn)病灶15個(gè)，其形態(tài)表現(xiàn)主要為橢圓形，且血腫邊界較清晰，大小在40-5-HU。其余的5例患者呈現(xiàn)蜂窩樣改變（如圖4），表現(xiàn)出低密度的蜂窩樣陰影，內(nèi)有許多小圓形的、裂隙樣的氣影，邊界模糊不清。根據(jù)患者的表現(xiàn)又可分為四個(gè)不同的時(shí)期：+型：患者肺組織周圍實(shí)質(zhì)內(nèi)有液氣平面或沖氣囊腔，個(gè)別的患者會(huì)伴氣胸出現(xiàn)，這種情況是由于胸壁在受到暴力壓迫產(chǎn)生的肺組織的破裂，是最常見的一種表現(xiàn)形態(tài)。+型：主要變現(xiàn)為患者肺組織內(nèi)的氣壓平面或氣囊性病變的病灶部位位于脊柱兩側(cè)，其形成主要是因?yàn)榛颊叻谓M織受壓而導(dǎo)致移位從而形成的肺撕裂，這種情況也比較多見。+型：這種情況的發(fā)生大多是由于患者收到外力作用導(dǎo)致的鄰近肋骨骨折使得胸椎骨穿破肺組織，影像學(xué)上主要表現(xiàn)為線樣透亮影和靠近胸壁的地方出現(xiàn)小囊腫，患者通常會(huì)伴有一定程度上的皮下出血或伴氣液胸發(fā)生。+型：臨床上這樣的情況一般來說比較少見，主要由胸膜鄰近的肺組織受壓過大產(chǎn)生或由肋骨骨折撕裂引起，在臨床醫(yī)學(xué)影像學(xué)檢查中，常常會(huì)被其他類型的影響掩蓋，很難輕易發(fā)現(xiàn)。實(shí)驗(yàn)結(jié)果顯示多層螺旋CT 是一種全面性強(qiáng)、可重復(fù)操作的、操作簡單有效性強(qiáng)的一種醫(yī)學(xué)影像學(xué)檢查方式，CT技術(shù)在臨床診斷中的應(yīng)用，可以清晰地觀察到患者體內(nèi)肺部組織的病灶部位的分布、大小、演變和范圍等相關(guān)信息，是現(xiàn)在各大醫(yī)院檢查PL的一種重要的醫(yī)學(xué)手段。2.3CT復(fù)查結(jié)果根據(jù)患者的肺撕裂傷程度不同，按患者程度共分為段復(fù)查，其中1-5天內(nèi)復(fù)查患者20例，患者圖像表現(xiàn)為肺氣囊腫腔內(nèi)有液體進(jìn)入形成肺氣液囊腫，出現(xiàn)液平現(xiàn)象，且肺部撕裂傷范圍比首次CT觀察時(shí)明顯增多，病灶部位周邊模糊不清；在6-21天進(jìn)行復(fù)查的患者有18例，患者復(fù)查后的圖像顯示，患者的肺氣液囊腔內(nèi)的液體較首次檢查增多明顯，形成高液平面，患者肺氣液囊周圍的毛玻璃樣陰影呈逐漸淡化的情況，表明被逐漸吸收，使得患者病灶部位周圍越來越光滑，之前展現(xiàn)的大片非邊緣模糊出血性病灶逐漸形成邊緣清晰的血腫。在22-3個(gè)月左右復(fù)查的患者共有12例，CT影像顯示，患者的肺氣液囊腫、肺氣囊腫出現(xiàn)逐漸減少的趨勢，甚至消失不見，邊界線變得清晰，又可見纖維樣條縮影，患者的病灶部位開始逐漸縮小，其他無明顯變化。10例患者在6個(gè)月至一年內(nèi)復(fù)查，血腫尚未完全吸收，影像表現(xiàn)為梭形的高密度陰影。從某種意義上可以簡單的說，肺撕裂傷要嚴(yán)重于單純的肺挫傷，且肺挫傷在吸收速度上要明顯優(yōu)于肺撕裂傷。肺撕裂傷與肺血腫在臨床上的吸收效果較慢，與報(bào)道相符。在一定程度上，臨床上應(yīng)用的MSCT在進(jìn)行費(fèi)密度指標(biāo)中肺容積測試與PFT肺通氣功能指標(biāo)有很好的相關(guān)性聯(lián)系。一定程度上MSCT能較為準(zhǔn)確的診斷出患者肺功能的改變部分功能可取代PFT檢查。2.4合并癥表現(xiàn)通過對(duì)所有患者的臨床表現(xiàn)發(fā)現(xiàn)，共有36例患者出現(xiàn)了撕裂傷中均能看到有不同程度的肺挫裂傷，未發(fā)現(xiàn)有大出血狀況，其表現(xiàn)主要為，患者肺撕裂部位或周圍鄰近的片狀、斑塊狀毛玻璃樣密度增高的陰影，縱膈肌出現(xiàn)積氣情況有6例患者表現(xiàn)明顯，心包內(nèi)積氣（見圖5）的患者6例，血?dú)庑?例，胸壁皮下廣泛存在積氣的患者10例；伴有肋骨骨折的患者26例，其中肩胛骨骨折的患者有3例，鎖骨骨折患者6例，胸椎或腰椎骨折16例，并外還有2例嚴(yán)重的患者伴有顱腦或腹部損傷，病情已基本上得到有效的緩解。臨床上常見的肺撕裂傷和肺損傷有時(shí)會(huì)發(fā)生同時(shí)存在的情況，所以嚴(yán)格意義上的CT分類也并不準(zhǔn)確，在肺組織受傷中，病灶常常以一種或多種不同形態(tài)同時(shí)存在，又是一可以相互之間轉(zhuǎn)換。肺液氣囊內(nèi)的液體在患者自身進(jìn)一步的吸收或隨著患者的新陳代謝排出后則會(huì)形成氣囊腔，而肺內(nèi)血腫也可以與引流支氣管通道進(jìn)行想通后形成也氣囊腔。3討論肺撕裂傷的發(fā)生機(jī)理，肺撕裂傷是指肺部實(shí)質(zhì)間出現(xiàn)的不同程度的破裂25，由于沖擊力的減速以及能量沖擊導(dǎo)致的創(chuàng)傷。通常患者會(huì)出現(xiàn)以下幾種情況：1）骨折牽拉造成肺組織撕裂、肺組織和胸膜粘連或胸壁受壓內(nèi)移形成的外傷性肺氣囊，如果進(jìn)入胸膜內(nèi)的是破裂產(chǎn)生的血液，則會(huì)形成液氣囊腫，如果完全被血液充滿就會(huì)形成肺內(nèi)血腫；2）肺組織被肋骨骨折直接刺破；3）肺組織在胸壁受擠壓時(shí)跨過脊椎產(chǎn)生剪切力，導(dǎo)致縱向撕裂；4）胸腔壁由于突然受到外界力的作用導(dǎo)致的彈性積壓，使得聲門在本能作用下自主關(guān)閉，從而形成的支氣管內(nèi)的壓強(qiáng)突然增大導(dǎo)致的遠(yuǎn)端肺泡的破裂。肺液、氣囊壁主要是由撕裂損傷的肺泡組織構(gòu)成，但其呈現(xiàn)在影像中沒有真性囊腫壁結(jié)構(gòu)，因此臨床上又將這種狀態(tài)成為外傷性假性囊腫，外傷性假性囊腫不光常見于受創(chuàng)同側(cè)的肺組織，也可能發(fā)生在對(duì)側(cè)的肺組織中，其存在約占胸部閉合傷的7%26。肺撕裂傷是臨床醫(yī)學(xué)上常見的胸部創(chuàng)傷之一，是由于患者受到較重的外力作用導(dǎo)致的肺部組織的撕裂，多于震蕩傷及胸部鈍性傷引發(fā)的內(nèi)部傷，但由于周圍的肺部組織的回縮，造成了胸腔內(nèi)壓強(qiáng)的變化，就會(huì)伴隨著產(chǎn)生血腫、肺液囊、肺氣囊等病癥，若患者病情急，死亡率