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肺吸入是指食物、胃内容物、口咽分泌物以及其他刺激性液体或碳氢化合物误吸入喉部以下呼吸道,可引起化学性吸入性肺炎和(或)细菌性吸入性肺炎[1]。肺吸入主要由以下一种或多种因素引起:口咽分泌物的误吸、胃食管反流以及吞咽功能障碍。按吸入的过程可分为顺行肺吸入和逆行肺吸入。顺行肺吸入主要发生在吞咽困难和吸入唾液时;逆行肺吸入发生在胃食管反流引起的误吸。吸入性肺炎是一种常见的、缺少典型特征的吸入综合征,可发生于任何年龄段,常见于儿童和老年人,其发病率高,严重者可发生呼吸衰竭和急性呼吸窘迫综合征,病死率高[2-3]。因此,早期诊断肺吸入极其必要。
目前尚无诊断肺吸入的“金标准”,常用的诊断方法有:胸片和高分辨率CT、纤维内镜吞咽功能检查(fiberoptic endoscopic evaluation of swallowing testing,FEES)、电视X线透视吞咽功能检查(videofluoroscopic swallowing study,VFSS)、放射性核素显像等。胸片和高分辨率CT通常用来评估肺吸入可疑的儿童,虽然在显示肺吸入造成的肺损伤时很有用,但必须要损伤达到一定程度才能发现异常,其灵敏度和特异度不高[4-5]。FEES能直观地获取吞咽过程中的解剖、咽部活动、感觉障碍等信息,能直接可视观察吞咽前和吞咽后的肺吸入[6]。FEES可以在床旁完成检查,而且没有辐射,安全,重复性好,但由于其是侵入性检查,常伴随并发症,如鼻出血、气道痉挛等[7]。VFSS可以在透视下动态观察整个吞咽过程以及是否有食团吸入下呼吸道,被认为是诊断吞咽功能障碍的金标准[8],此外还可评估患者吞咽过程的安全性和有效性以及治疗效果[9],但检查过程中患者的辐射剂量较大[10]。与以上的检查方法相比,放射性核素显像是完全符合生理条件下的无创性的检查方法,患者无需特殊准备,检查过程中受到的辐射剂量也很小,检测肺吸入的灵敏度高,可长时间观察肺吸入,并对肺吸入进行定量评估。
放射性核素显像在肺吸入诊断中的应用进展
Advances in radionuclide imaging for pulmonary aspiration
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摘要: 肺吸入是常见的呼吸系统疾病,因其缺少典型的临床症状,常常直到造成严重的肺损伤时才被发现,其发病率和病死率较高。因此,早期诊断肺吸入至关重要。肺吸入的发生机制复杂多样,临床特征不典型,又因对其缺少特异的诊断技术与方法,以致延误诊断和治疗时机的患者不在少数。在欧美国家,放射性核素显像是临床上诊断肺吸入的常用方法,但在国内相关的研究报道较少,笔者就放射性核素显像在肺吸入诊断中的进展作一综述。Abstract: Pulmonary aspiration is a common disease of respiratory system. The morbidity and mortality of the disease is high since it lacks typical clinical symptoms and generally can hardly be detected until severe lung damages caused. Consequently, early diagnosis of pulmonary aspiration is of vital importance. The pathogenetic mechanism of pulmonary aspiration is complicated and diverse. Since its clinical features are not atypical and specific diagnostic method is not available, there are lots of patients delayed in diagnosis and treatment. In the European and American countries, radionuclide imaging is the most commonly used clinical method for pulmonary aspiration diagnosis. However, there are few related researches and reports in China. The writer has summarized the progress of radionuclide imaging for pulmonary aspiration diagnosis.
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