Shao Shifeng, Wu Zhengbin, Liu Jun, Liao Zhikang, Yao Yuan, Zhang Liang, Wang Yaoli, Zhao Hui
Department of ICU, Daping Hospital, Army Medical University, Chongqing, 400042, China.
Department of Military Traffic Injury Prevention and Control, Daping Hospital, Army Medical University, No. 10 Changjiang Branch Road, Yuzhong District, Chongqing, 400042, China.
Sci Rep. 2025 Jan 18;15(1):2358. doi: 10.1038/s41598-025-86928-6.
The incidence of blast injuries has been rising globally, particularly affecting the lungs due to their vulnerability. Primary blast lung injury (PBLI) is associated with high morbidity and mortality rates, while early diagnostic methods are limited. With advancements in medical technology, and portable handheld ultrasound devices, the efficacy of ultrasound in detecting occult lung injuries early remains unclear. This study evaluates the effectiveness of immediate lung ultrasound in diagnosing PBLI. The study involved 25 healthy male Bama mini-pigs subjected to BST-I-type biological shock wave tubes. The pigs were randomly assigned to non-injured and injured groups with driving pressures of 4.0 MPa, 4.5 MPa, and 4.8 MPa. Four PBLI models were created: no injury, minor, moderate, serious and severe. Immediate lung ultrasound following the BLUE-PLUS protocol and arterial blood gas analysis were conducted pre-injury and 0.5 h, 3 h, 6 h, 12 h, and 24 h post-injury, respectively. The study analyzed lung ultrasound score differences and their correlations with lung function parameters, using ROC analysis to determine early diagnostic standards and mortality prediction efficacy. The study found that in cases of moderate and severe PBLI, lung ultrasound scores and AaDO significantly increased at 0.5 h post-injury, while PaO decreased. There was good consistency between left and right lung ultrasound results at all times. Lung ultrasound scores were significantly correlated with PaO and AaDO but not with PaCO. The scores accurately predicted injury severity at various time points within 24 h post-injury, and the 0.5 h lung ultrasound score predicted 24 h mortality with 95.8% efficiency. PBLI exhibits hidden severity, necessitating improved early diagnostics. Immediate lung ultrasound provides effective differentiation for moderate and severe PBLI at multiple time points within 24 h post-injury, is easy to implement, and offers effective mortality risk prediction as early as 0.5 h post-injury. These findings underscore lung ultrasound's significant clinical application value in pre-hospital early treatment settings for PBLI.
全球范围内，爆震伤的发生率一直在上升，由于肺部较为脆弱，因此受到的影响尤为明显。原发性爆震性肺损伤（PBLI）的发病率和死亡率都很高，而早期诊断方法有限。随着医疗技术的进步以及便携式手持超声设备的出现，超声早期检测隐匿性肺损伤的效果仍不明确。本研究评估即时肺部超声诊断PBLI的有效性。该研究纳入了25只健康雄性巴马小型猪，使其接受BST-I型生物冲击波管冲击。这些猪被随机分为非损伤组和损伤组，驱动压力分别为4.0兆帕、4.5兆帕和4.8兆帕。创建了四种PBLI模型：无损伤、轻度、中度、重度和极重度。分别在损伤前以及损伤后0.5小时、3小时、6小时、12小时和24小时，按照BLUE-PLUS方案进行即时肺部超声检查，并进行动脉血气分析。该研究分析了肺部超声评分差异及其与肺功能参数的相关性，采用ROC分析来确定早期诊断标准和死亡率预测效能。研究发现，在中度和重度PBLI病例中，损伤后0.5小时肺部超声评分和肺泡动脉氧分压差（AaDO）显著升高，而动脉血氧分压（PaO）降低。左右肺超声检查结果在各个时间点均具有良好的一致性。肺部超声评分与PaO和AaDO显著相关，但与动脉血二氧化碳分压（PaCO）无关。这些评分在损伤后24小时内的各个时间点都能准确预测损伤严重程度，且0.5小时的肺部超声评分预测24小时死亡率的效能为95.8%。PBLI具有隐匿性严重程度，需要改进早期诊断方法。即时肺部超声在损伤后24小时内的多个时间点对中度和重度PBLI具有有效的鉴别作用，易于实施，并且在损伤后0.5小时即可提供有效的死亡风险预测。这些发现强调了肺部超声在PBLI院前早期治疗中的重要临床应用价值。
