| Purpose:To evaluate chest CT manifestations in patients with various stages of acute hydrogen sulphide poisoning and its change law of development, provide a basis for classification of acute lung injury after hydrogen sulfide poisoning, To explore correlation between chest CT score of lung injury of acute hydrogen sulfide poisoning and oxygenation index whether CT score can be applied to assess acute lung injury after acute hydrogen sulfide poisoning and provide basis and reference.Materials and methods:The clinic and a series of CT datas of 62 acute hydrogen sulphide poisoning cases were retrospectively analysed and compared,According to the diagnostic standard of occupational H2S acute poisoning,these patients were divided into 3 grouds including mild groud,moderate groud,severe groud. According to the acute phase,disperse phase and convalescence stage,observed and statisticsed the lung images change;A lung lobe acted a unit of analysis,The left lung was analyzed according to upper lobe,lower lobe and the whole lung.The right lung was analyzed according to upper lobe,middle,upper and middle lobes,middle and lower lobes,the whole lung;Imaging findings was analyzed according to patchy ground glass shadow, large sheet ground glass shadow, patchy consolidation, large sheet consolidation, edge blur lobules centre nodules, interstitial change;The CT score were improved, referenceing the chest X-ray;The CT score difference were analyzed between moderate and severe group in acute phase and disperse phase; The oxygenation index were analyzed between moderate and severe group in acute phase and disperse phase; The correlation between chest CT score of lung injury of the acute hydrogen sulfide poisoning and oxygenation index were analyzed;. Statistical software SPSS 17.0 was used to analyze the data. K-S test was used to test the normality test. If the data were subject to normal distribution, mean± standard deviation was used to discribe the data, and two independent sample t-test was used to compare between groups, the Pearson correlation analysis was used to describe the correlation between CT score and oxygenation index;If the data were not subject to normal distribution, the Wilcoxon rank correlation analysis was used to describe the data, the Spearman correlation analysis was used to alalysis the correlation between CT score and oxygenation index. There was significant difference between two groups (P<0.05).Results:1 The classification stage CT performance of lung injury after acute hydrogen sulfide poisoning.Mild groud 30 cases (30/62).CT of acute stage showed acute trachea-bronchitis or bronchial inflammation around.18 cases (60%) were the normal image performance, 12 cases (40%) were pulmonary vascular texture slightly enlargement,fuzzy;1 case with both sides of a small amount of pleural effusion,1 case with one side of a small amount of pleural effusion. Disperse phase, after 4-8 days treatment 8 cases were reviewed, CT showed no new lesions and no fibrous remnant.Moderate groud 23 cases (23/62), In acute phase CT performanced acute chemical bronchial pneumonia. There were 4 cases (17.39%) in superior lobe of right lung,6 cases (26.09%) in middle lobe of right lung,13 cases(56.52%) in lower lobe of right lung.6 cases (26.09%) in superior lobe of left lung,15 cases (65.22%) in lower lobe of left lung,;There were 15 cases (65.22%) in the form of patchy ground glass shadow,12 cases (52.17%) in the form of edge blur lobules centre nodules,10 cases(43.48%) in form of patchy consolidation,9 cases in the form of interstitial change,6 cases(26.09%) in the form of bronchial double-track sign.3 cases with both sides of a small amount of pleural effusion,1 case with one side of a small amount of pleural effusion; Patchy ground glass shadow, patchy consolidation, edge blur lobules centre nodules, interstitial change and the bronchial double-track sign were all distributed in lower lobe of two lung. Dissipation phase,18 cases after 3-5 days treatment were reviewed, the lung lesions were significantly absorbed, the lesions were clear; 2 cases with bilateral pleural effusion were absorbed,2 cases had a small amout of pleural effusion. The recovery phase,6 cases after 8-15 days treatment were reviewed, the lung lesions were absorbed, and 3 cases with fibrous remnant.Severe groud 9 cases (9/62).Acute phase CT showed pulmonary edema:1 case (11.11%) showed diffuse alveolar pulmonary edema, showed two pulmonary diffuse patchy distribution of a large patch of ground glass shadow with consolidation shadows;8 cases (88.89%) showed central pulmonary edema, showed two sides butterfly wing lung distribution of ground glass shadow, mainly in the inner zone, the gradually increasing density distribution along the line of gravity direction, focal edge were not clear; 6 cases with consolidation shadow with bronchial inflatable sign. Dissipation phase,9 cases after 4-6 days treatment were reviewed, the lung lesions were obvious absorbed.Recovery phase,9 cases after 8-10 days treatment were reviewed,nodular lesions shadow were smaller, some were absorbed completely;3 cases after 58-60 days treatment were reviewed with fibrous remnant, including 1 case after 100 days treatment with fibrous remnant.2 The correlation between chest CT score of lung injury of the acute hydrogen sulfide poisoning and oxygenation indexThe CT score of 23 cases with acute stage and dissipation stage of moderate poisoning group were respectively 2.26±1.37,1.34±0.65;The CT score of 9 cases with acute stage and dissipation stage of severe poisoning group were respectively 11.67±3.12,4.55±2.45. CT scores of 23 cases with moderate groud and 9 cases with severe group were significantly different (t=8.811, P<0.01) in the acute phase;CT scores of 23 cases with moderate groud and 9 cases with severe groud were significantly different (t=3.289, P<0.05) in the dissipation; CT score with severe groud were significantly higher than moderate group in the acute phase and dissipation phase.The oxygen index of the 19 cases in the acute phase were 303.58±26.90, and the oxygen index of the 8 cases in the dissipation phase was 435.32±37.34;The oxygen index of the 9 cases in the acute phase and the dissipation phase were 193.17±36.41,347.67±44.49. The oxygen partial pressure and oxygenation index in the severe group were significantly lower than those in the moderate group (t=8.60 and 9.06, P<0.01) in the acute phase, and the oxygen partial pressure and oxygenation index in the severe group were significantly lower than those in the moderate group (t=4.21 and 4.38, P<0.01) in the dissipation phase.At the level of P<0.05, the CT score was negatively correlated with the oxygen index in the acute phase and in the dissipation phase.Conclusions:Lung injury after acute hydrogen sulfide poisoning:Mild poisoning case showed mild in acute stage, no lesion of alveolar infiltration, no delayed lesion in the dissipation stage. Moderate poisoning cases in acute stage showed mainly two lung leaf patchy ground glass opacities, with patchy opacities,the lesion were absorbed in dissipation stage. Severe poisoning cases showed diffuse distribution or the distribution of the butterfly wing ground glass opacities with bronchial inflatable sign in the acute stage;The lesions were absorbed, the lesions were clear, and the density was pale in th dissipation stage. Chest CT can be used to reflect the changes of the lung injury after acute hydrogen sulfide poisoning, and the CT score of lung injury and oxygenation index is negatively correlated. The CT score can be used to evaluate the degree of lung injury, and can be used in the evaluation of acute lung injury after acute hydrogen sulfide poisoning. |
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