吸入性肺损伤的研究进展.docVIP

吸入性肺损伤的研究进展` Abstract Objective—Aspiration of oropharyngeal or gastric contents into the lower respiratory tract is a common event in critically ill patients, and can lead to pneumonia or pneumonitis. Aspiration pneumonia is the leading cause of pneumonia in the intensive care unit and is one of the leading risk factors for acute lung injury and acute respiratory distress syndromes. An accurate ability to diagnose aspiration is paramount as different modalities of therapy, if applied early and selectively, could change the course of the disease. Conclusions—Aspiration in the intensive care unit is a clinically relevant problem requiring expertise and awareness. A definitive diagnosis of aspiration pneumonitis or pneumonia is challenging to make. Advances in specific biomarker profiles and prediction models may enhance the diagnosis and prognosis of clinical aspiration syndromes. Evidence-based management is supportive, including mechanical ventilation, bronchoscopy for particulate aspiration, consideration of empiric antibiotics for pneumonia treatment, and lower respiratory tract sampling to define pathogenic bacteria that are causative. Keywords Aspiration; aspiration pneumonitis; aspiration pneumonia; acute lung injury; acute respiratory distress syndrome; 摘要 目的：危重病人的口咽分泌物或胃内容物常常吸入下呼吸道并导致肺炎，吸入性肺炎占危重患者肺炎的较大部分，并是导致急性肺损伤（ALI）、急性呼吸窘迫综合症（ARDS）重要的风险因子之一。与治疗方法比较，准确的诊断误吸极为重要，如早期诊断，它将改变疾病的发展过程。结论：危重患者的误吸是一个与专业技能和专业意识相关的临床问题，确诊吸入性肺炎具有挑战性，特定的生物标记和预测模型的发展有助于诊断和预后。询证医学证明的临床管理是有效的，其包括机械通气、支气管镜检查、慎重的经验性抗感染治疗和明确病原学诊断的下呼吸道取样。 关键词 误吸，吸入性化学性肺炎，吸入性细菌性肺炎，急性肺损伤，急性呼吸窘迫综合症 危重患者由于误吸诱导的肺损伤通常难以及时诊断，且大部分伴有肺功能障碍，而且它被认为是继发肺炎或ALI/ARDS独立的危险因子。尽管胃内容物误吸诱导的肺损伤在临床上极为重要，我们对其发展为严重感染和ALI/ARDS 的基本机制知之甚少。而且，我们总结了动物模型胃内容物误吸诱导的急性肺损伤炎症机制和鉴别急性肺损伤炎症特征，特别是包括啮齿类动物（老鼠）模型关于弱酸诱导的吸入性损伤，如同时发现胃内容物将进一步恶化。这将使基于炎性因子和生物标记建立的统计学预测模型来诊断不同类型的吸入物成为可能。本文就吸入性肺损伤的定义、发病率、风险因子、发病机制，诊断及治疗综述如下。 1.定义 误吸被定义为外来物吸入进声带以下的气道，吸入物的成分是不同的，它由分泌物、血液、细菌、液体、食物残渣组成。误吸可能是显性或隐性的，而且误吸也可能是很少导致急性症状的反复的小误吸。误吸不同于胃内容物进入口咽或食道的返流，尽管鉴别二者是非常困难