课件：吸入性肺炎的诊断及治疗.ppt

* Left:Chest CT scans show subcarinal lymphadenopathy (arrow), small bilateral pleural effusions, and radiation pneumonitis in the medial portion of left upper lung zone. Right: Two weeks later, acute onset of symptoms suggestive of pneumonia have developed in this patient on a course of radiation therapy.Chest radiograph shows consolidation in right upper lobe and left perihilar area. Follow-up CT scans show complete necrosis and cavitation of the subcarinal lymph node (arrow), resulting in bronchoesophageal fistula and aspiration pneumonia in both upper lobes. * * A 6-year-old white boy with a history of developmental delay and a seizure disorder was found to have an infiltrate in his RUL on a CXR obtained during an orthopedic evaluation for thoracic scoliosis. He had no signs or symptoms of respiratory disease at that time. He was treated with one 10-day course each of amoxicillin with clavulanic acid and cefazolin during a 2-month period. The patient continued to be asymptomatic, but a follow-up CXR showed persistence of the infiltrate and the patient was referred to our center for further evaluation. The patient had a long history of constipation with daily use of mineral oil. He was fed by mouth and had occasional episodes of coughing and choking during feeding. * * * * * * * * 吸入性肺炎的临床表现 体征 两肺可闻及湿罗音，可伴干鸣音，严重者可发生呼吸窘迫综合征。 影像学表现 § 吸入1～2小时出现两肺散在不规则片状边缘模糊阴影，常见于中下肺野，右肺多见。 §发生肺水肿出现片状、云絮状阴影融合成大片状，从两肺门向外扩散，以两肺中内带为明显，与心源性急性肺水肿的X线表现相似，但心脏大小和外形正常，无肺静脉高压征象。 脑血管意外后吸入性肺炎 资料可以编辑修改使用 资料来源网络，如有侵权联系删除，不负法律责任谢谢 感谢您的观看和下载 资料仅供参考，实际情况实际分析 硬皮病合并肺纤维化 64岁男性患者 蜂房 食管扩张 外因性类脂质肺炎 Bandla HP, et al. Pediatrics 1999;103(2):e19 持续癫痫致吸入性肺炎 吸入性肺炎当前的误区 ● “不知道吸入性肺炎很常见” ● 不能鉴别吸入性化学性肺炎和吸入性细菌性肺炎 ● 倾向于认为所有误吸的肺部并发症都是感染性的 ● 误解必须目睹误吸才能建立诊断 后4条引自 Marik PE.N Engl J Med, 2001,344:665-671 疑有吞咽困难的临床征象 Marik PE, et al. CHEST, 2003, 124:328-336 流涎或食物从口中淌下 吞咽起始延迟 吞咽之前、过程中或之后发生咳嗽或呛咳 执行吞咽动作后甲状软骨/咽部提升水平减少或不提升 疑有吞咽困难的临床征象 一口食物需多次吞咽 食物或液体从鼻中泄漏 口腔隐藏食物 进食频率缓慢 吞咽疼痛 口腔/咽喉感觉减弱 医疗机构收容所老年重症吸入性肺炎病原菌调查 病原