超声诊断创伤性气胸的实验研究

目的通过体外实验及动物实验研究，探讨超声在诊断创伤闭合性气胸及确定肺部损伤破口位置中的应用价值。 方法建立体外和动物创伤闭合性气胸模型，体外实验操作者分为临床医师组8人和超声医师组8人，2组分别在人工胸腔积液背景下检查体外创伤性气胸模型（呼吸气囊模型），探查呼吸气囊破口的位置并记录诊断所用时间。动物实验选用12只五指山小型猪建立创伤闭合性气胸模型，将12只动物分为实验组（人工胸腔积液组）和对照组（无人工胸腔积液组），应用超声检查对2组的气胸情况进行诊断评估，探查肺损伤破口的位置并记录诊断所用时间。 结果体外实验2组医师均探查到呼吸气囊漏气的位置并记录特异性诊断图像，超声医师组和临床医师组分别用时（45±18）s、（60±32）s，2组比较差异无统计学意义（t=1.16，P>0.05）。动物实验对照组超声影像均表现为肺滑动征和A线消失，部分可见肺点，肺滑动征消失显示率100.0%（6/6），肺点显示率66.7%（4/6），对照组所有实验动物超声检查均无法确定肺部损伤位置。实验组除可见肺滑动征和A线消失，在人工胸腔积液背景下还可见到连续性气泡溢出的高回声特异性影像进而可以确定肺部损伤的位置。对照组诊断用时（300±53）s，实验组诊断用时（180±35）s，2组比较差异有统计学意义（t=4.63，P<0.05）。 结论体外实验及动物实验均证实超声可以诊断创伤闭合性气胸，且可在人工胸腔积液背景下精准定位肺损伤破口的位置。超声对于创伤闭合性气胸的精准诊断为进一步的介入治疗奠定了基础，人工胸腔积液的应用为创伤性气胸的诊治提供了新思路。

Diagnosis of traumatic pneumothorax by ultrasonography: an experimental study

ObjectiveTo explore the application value of ultrasound in diagnosing traumatic pneumothorax and determining the location of lung injury through in vitro and animal experiments. MethodsTraumatic pneumothorax models were established both in vitro and in vivo. In in vitro experiments, a balloon leakage model (a traumatic pneumothorax models in vitro) under the background of liquid was examined by clinicians and ultrasonographists. The location of balloon leakage was identified, and the specific ultrasound images of continuous bubble spillover and examination time were recorded. In animal experiments, 12 Wuzhishan pigs were randomly divided into either an experimental group (artificial pleural effusion group) or a control group (no artificial pleural effusion group), with six pigs in each group. Traumatic pneumothorax was induced in all animals. Ultrasound images and examination time were recorded in both groups. Specific ultrasound images were read to determine the location of pulmonary rupture. ResultsIn in vitro experiments, the examination time in the clinician and ultrasonographist groups was (60±32) s and (45±18) s, respectively, and there was no significant difference between the two groups (t=1.16, P>0.05). In animal experiments, pulmonary sliding sign and A-line disappeared in all animals of the control group (6/6), with pulmonary point found in some cases (4/6). In the experimental group, besides the disappearance of lung sliding sign and A-line, the specific images of continuous bubble spillover and examination time could be recorded in the background of artificial pleural effusion, which can determine the location of pulmonary rupture. The time spent for diagnosis was significantly longer in the control group than in the experimental group [(300±53) s vs (180±35) s, t=4.63, P<0.05]. ConclusionBoth in vitro and animal experiments confirmed that ultrasound can diagnose traumatic pneumothorax and accurately determine the location of lung injury under the background of artificial pleural effusion. Accurate ultrasound diagnosis can lay a foundation for further interventional treatment of traumatic pneumothorax. The application of artificial pleural effusion provides a new idea for the diagnosis and treatment of traumatic pneumothorax.