围手术期中胃内容物的肺吸入相对罕见,并且发生率在过去数十年期间尚未改变。[4]Ng A, Smith G. Gastroesophageal reflux and aspiration of gastric contents in anesthetic practice. Anesth Analg. 2001;93:494-513.http://www.anesthesia-analgesia.org/content/93/2/494.fullhttp://www.ncbi.nlm.nih.gov/pubmed/11473886?tool=bestpractice.com 在美国,成人和儿童的胃内容物误吸发病率似乎近似(成人:3.1/10,000;儿童:3.8/10,000),[5]Warner MA, Warner ME, Weber JG. Clinical significance of pulmonary aspiration during the perioperative period. Anesthesiology. 1993;78:56-62.http://www.ncbi.nlm.nih.gov/pubmed/8424572?tool=bestpractice.com[6]Warner MA, Warner ME, Warner DO, et al. Perioperative pulmonary aspiration in infants and children. Anesthesiology. 1999;90:66-71.http://www.ncbi.nlm.nih.gov/pubmed/9915314?tool=bestpractice.com 但一项研究表明该病可能在儿童中更常见 (10.2/10,000)。[7]Borland LM, Sereika SM, Woelfel SK, et al. Pulmonary aspiration in pediatric patients during general anesthesia: incidence and outcome. J Clin Anesth. 1998;10:95-102.http://www.ncbi.nlm.nih.gov/pubmed/9524892?tool=bestpractice.com 在斯堪的纳维亚教学医院,全身麻醉时,该发生率在 0.7/10,000 和 4.7/10,000 之间变动。[8]Olsson GL, Hallen B, Hambraeus-Jonzon K. Aspiration during anaesthesia: a computer-aided study of 185,358 anaesthetics. Acta Anaesthesiol Scand. 1986;30:84-92.http://www.ncbi.nlm.nih.gov/pubmed/3754372?tool=bestpractice.com 然而,在严重外伤时,总误吸发生率可以高达 38%。[9]Lockey DJ, Coats T, Parr MJ. Aspiration in severe trauma: a prospective study. Anaesthesia. 1999;54:1097-1098.http://www.ncbi.nlm.nih.gov/pubmed/10540100?tool=bestpractice.com 误吸按每 3000 个麻醉病例 1 起的频率出现并且在麻醉相关死亡病例中占到10%至30%。[2]Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 2001;344:665-671.http://www.ncbi.nlm.nih.gov/pubmed/11228282?tool=bestpractice.com 虽然误吸发生率保持低并相对恒定的水平,但是虚弱及年老人群接受外科手术的情况现在越来越普遍,而他们预计更容易发生误吸。[4]Ng A, Smith G. Gastroesophageal reflux and aspiration of gastric contents in anesthetic practice. Anesth Analg. 2001;93:494-513.http://www.anesthesia-analgesia.org/content/93/2/494.fullhttp://www.ncbi.nlm.nih.gov/pubmed/11473886?tool=bestpractice.com 在正在接受肠内营养的住院患者中,报告的患病率浮动范围较大,从 4.4%[10]Mullan H, Roubenoff RA, Roubenoff R. Risk of pulmonary aspiration among patients receiving enteral nutrition support. JPEN J Parenter Enteral Nutr. 1992;16:160-164.http://www.ncbi.nlm.nih.gov/pubmed/1556813?tool=bestpractice.com 至接近 90%,[11]Metheny NA, Clouse RE, Chang YH, et al. Tracheobronchial aspiration of gastric contents in critically ill tube-fed patients: frequency, outcomes, and risk factors. Crit Care Med. 2006;34:1007-1015.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2396145/http://www.ncbi.nlm.nih.gov/pubmed/16484901?tool=bestpractice.com 此情况取决于如何定义误吸(隐性与症状性)、诊断方法、饲管在消化道的位置(鼻胃管或鼻空肠管)和饲管类型(鼻胃管或胃造口管)。然而,有临床证据的误吸较为少见,仅在 <1% 的肠内营养患者中可观察到。[11]Metheny NA, Clouse RE, Chang YH, et al. Tracheobronchial aspiration of gastric contents in critically ill tube-fed patients: frequency, outcomes, and risk factors. Crit Care Med. 2006;34:1007-1015.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2396145/http://www.ncbi.nlm.nih.gov/pubmed/16484901?tool=bestpractice.com
放射检查期间钡造影剂意外误吸是罕见的,但可以在多达 8%的胃食管反流儿童中发生。[12]Fung KP, Seagram G, Pasieka J, et al. Investigation and outcome of 121 infants and children requiring Nissen fundoplication for the management of gastroesophageal reflux. Clin Invest Med. 1990;13:237-246.http://www.ncbi.nlm.nih.gov/pubmed/2276217?tool=bestpractice.com 肺损伤的严重程度取决于悬液的密度,高密度硫酸钡造成最严重的损伤并可能致命,尤其在老年患者中。[3]Gray C, Sivaloganathan S, Simpkins KC. Aspiration of high-density barium contrast medium causing acute pulmonary inflammation: report of two fatal cases in elderly women with disordered swallowing. Clin Radiol. 1989;40:397-400.http://www.ncbi.nlm.nih.gov/pubmed/2758750?tool=bestpractice.com[13]Tamm I, Kortsik C. Severe barium sulfate aspiration into the lung: clinical presentation, prognosis and therapy. Respiration. 1999;66:81-84.http://www.ncbi.nlm.nih.gov/pubmed/9973698?tool=bestpractice.com[14]Ansell G. Alimentary tract. In: Ansell G, Bettmann MA, Kaufman JA, et al, eds. Complications in diagnostic imaging and interventional radiology. 2nd ed. Oxford, UK: Blackwell Scientific; 1987:218-219.
[Figure caption and citation for the preceding image starts]: 支气管镜检查显示一位肺移植患者在钡餐检查后误吸入右主支气管内的硫酸钡由 Kamran Mahmood 医生提供 [Citation ends].