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老年人外源性类脂质肺炎14例

Report of 14 cases of exogenous lipoid pneumonia in the elderly

摘要:

目的 了解外源性类脂质肺炎的临床特征并初步探讨该病在老年人中的特征. 方法 结合我院所收治的14例老年人外源性类脂质肺炎进行分析. 结果 14例患者中,男7例、女7例,主要症状包括呼吸困难(50.0%)、干咳(35.7%),常见体征为爆裂音(28.6%)、湿哕音(21.4%);常见吸人原因中,由于慢性便秘或鼻炎等鼻腔疾病吸入脂类物质者最多见(35.7%),部分老年人由于老年痴呆误吸入脂类物质(21.4%).X线或CT更多表现为类肿瘤样肿块表现(42.9%)及渗出性斑片影(64.3%),极易误诊为肿瘤.14例(100.0%)均被诊断为肺炎或肺部肿瘤,后经病理确诊;其中2例为支气管肺泡灌洗液及活检诊断,其余10例则均由肺叶切除等有创检查手段取材确诊,2例尸检证实.目前外源性类脂质肺炎尚缺乏有效治疗手段. 结论 由于基础疾病影响(如便秘),老年人可能更容易获得外源性类脂质肺炎,症状常不典型,较年轻人常更严重,影像学表现酷似肺部肿瘤或肺炎,所以常被误诊;不能及时诊断并去除病因有可能导致慢性间质纤维化或致死;临床医生须加强认识,遇到以干咳及呼吸困难为主要表现、肺部出现湿哕音或爆裂音等体征的老年人,影像学表现为肺部炎症或肿瘤者,在一般治疗无效情况下,要考虑到脂质性肺炎可能性;追寻脂质吸入史是及时诊断并治疗的关键,恰当的肺泡灌洗术即有可能完成对该病的确诊.

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abstracts:

Objective To investigate the clinical characteristics of exogenous lipoid pneumonia and to explore the characteristics of the elderly with the disease.Methods 14 cases of elderly patients with exogenous lipoid pneumonia in Beijing Hospital were analyzed.Results Among the 14 patients(7 male and 7 female),main symptoms included dyspnea (50.0 %),cough (35.7 %),and the common signs were crackles (28.6 %) and wet rales (21.4 %).For exogenous lipoid pneumonia,the most common causes of inhalation of lipoid substances included chronic constipation,nasal cavity diseases such as rhinitis (35.7%).Some of elderly dementia patients may wrong inhale lipoid substances(21.4 %).X ray or CT features of exogenous lipoid pneumonia showed a tumor-like mass or lesions (42.9%)and the exudative plaque (64.3%),both of which were easily misdiagnosed as tumor.All of the 14 cases(100%) were misdiagnosed as "pneumonia" or "lung tumor",and finally confirmed by pathological diagnosis.Among the 14 cases,2 cases were diagnosed by cytopathology of bronchial alveolar lavage fluid or by transbronchial lung biopsy,10 cases were diagnosed by invasive examination methods like lobe resection,and 2 cases were confirmed by autopsy.At present,there is still a lack of effective treatment methods for exogenous lipoid pneumonia.Conclusions Due to the basal disease(such as constipation)action,the elderly may easily have access to exogenous lipoid pneumonia with atypical symptoms,might have more serious manifestations than younger adults,and may have X ray or CT imaging similar to lung cancer or pneumonia.So it is often misdiagnosed.If the patients cannot be timely diagnosed and the causes cannot be removed,it is likely to cause chronic interstitial fibrosis or death.Clinicians must increase the awareness of,and take into account the possibility of lipoid pneumonia,especially meeting the elderly patients with dry cough and dyspnea,rales or crackles and X-ray or CT tumor-like imaging as main manifestation resembling pulmonary inflammation or tumor without treatment futility after common antibiotic treatment.

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作者: 谭政 [1] 许小毛 [1] 杨菁菁 [1] 柯会星 [1]
期刊: 《中华老年医学杂志》2016年35卷11期 1187-1191页 ISTICPKUCSCD
栏目名称: 临床研究
DOI: 10.3760/cma.j.issn.0254-9026.2016.11.012
发布时间: 2016-12-20
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