静脉注射海洛因者胸部病变的X线表现与诊断.DOCVIP

临床医学论文-静脉注射海洛因者胸部病变的X线表现与诊断 【关键词】? 海洛因；肺部感染；X线摄影 　　［摘要］ 目的：探讨静脉注射海洛因者胸部病变的X线表现与诊断。方法：回顾性分析35例静脉注射海洛因者胸部病变的临床、影像学资料，全部病例均作2次以上胸片检查。结果：初诊胸片示：肺纹理增强、模糊20例，局部肺纹理减少5例；片状模糊阴影20例，小结节13例，小空洞18例，肺气囊19例；胸腔积液10例，气胸2例，液气胸2例；心影增大12例，肺动脉高压6例。复诊：新出现小空洞8例，肺气囊6例，小结节4例。结论：静脉注射海洛因者肺部感染的X线表现复杂多样、多变，多发小结节、小空洞及肺气囊对静脉注射海洛因者肺部感染的诊断价值颇大，明确静脉注射海洛因史是诊断的前提。　　　　［关键词］ 海洛因；肺部感染；X线摄影 　　Xray Appearance and Diagnosis of Chest Disease Due to Intravenous Heroin Abuse 　　Abstract：Objective To study Xray appearance and diagnosis of chest disease due to intravenous heroin abuse.Methods Thirtyfive cases of clinically confirmed chest disease due to interavenous heroin abuse are retrospectively analyzed.All of cases had two and more Xray examinations for chest.Results The first chest film found:lung making manifold (15 cases),cocal lung making reducing (5 cases),multiple patchy shadow (20 cases),small node (13 cases),small cavity (18 cases),pneumatocele (19 cases),pleural effusion (10 cases),peneumothorax (2 cases),hydropneumothorax (2 cases),megacardia (12 cases),pulmonary hypertension (6 cases).The second chest film found:new cavity (8 cases),new pneumatocele (6cases),new node (4 cases).Conclusion The Xray appearance of chest inflammation due to intravenous heroin abuse are multiple and changeful.The multiple small nodes,small cavities and pmeumatoceles sign have larger value in the diagnosis of lung inflammation due to intravenous heroin abuse.To confirm the history of intravenous heroin abuse is the premise for the diagnosis. 　　Key words：Heroin;Pneumonia;Radiography 　　静脉注射海洛因可造成人体多器官的损害，主要引起右心内膜炎及肺部感染。为了加深认识静脉注射海洛因者胸部病变的X线表现，我们收集了自1994年至2005年35例静脉注射海洛因致胸部病变的病例，并对其X线表现作了回顾性分析。 　　1　材料与方法 　　男30例，女5例，年龄18岁~41岁，平均年龄26.3岁。静脉注射海洛因史14个月~6 a；病程2周~3个月。均承认静脉吸毒史，其中5例入院时主动承认，其余病例均经多次追问才承认吸毒史。35例均有畏寒、发热(体温38 ℃~41 ℃)，咳嗽、咳痰28例，咯脓血痰8例,气促18例,胸痛8例，血尿3例,双下肢浮肿7例,听诊肺部干湿性音22例,胸腔积液征12例，三尖瓣听诊区收缩期杂音15例，P2亢进6例。35例尿海洛因试验阳性，WBC＞10×109/L。血液细菌培养阳性30例，其中金黄色葡萄球菌16例，表皮葡萄球菌7例，链球菌5例，肺炎双球菌2例。临床诊断肺部感染35例，液气胸2例，气胸2例，胸腔积液10例，心肌炎2例，心包积液2例，右心内膜