防治鼻咽癌放疗术后误吸(15例临床分析)

Prevention and Treatment of Aspiration Pneumonopathy after Radiotherapy of Nasopharyngeal Carcinoma

目的 探讨鼻咽癌放疗术后患者并误吸的临床防治。方法 对 15例鼻咽癌放疗术后并误吸患者均予常规抗感染、翻身、拍背、吸痰、体位引流、化痰、促胃肠动力药 (吗叮啉 )及饭后坐位 2h等治疗 ,其中 6例Ⅰ、Ⅱ度误吸患者有 3例经上述处理后症状已控制 ,2例加留置胃管 ,1例加留置空肠管 ;9例Ⅲ、Ⅳ度误吸患者中 4例为急性严重误吸并严重低氧血症者均行早期纤支镜吸痰后症状及低氧血症很快明显改善 ,但反复发作而 2例行气管切开术气管套管佩带气囊并留置胃管 ,2例行胃永久性造瘘术 ,余 5例慢性顽固性误吸者中 2例行气管切开术并气管套管佩带气囊 ,3例行胃永久性造瘘术。结果 15例患者均能较好地改善低氧血症及减少了误吸的发生 ,再无出现吸入性肺炎。结论 对鼻咽癌放疗术后Ⅰ、Ⅱ度误吸患者应选用内科保守治疗 ;Ⅲ、Ⅳ度慢性顽固性误吸患者应外科手术治疗 。

Objective To discuss the clinical prevention and treatment of aspiration pneumonopathy after radiotherapy of nasopharyngeal carcinoma. Methods 15 cases of nasopharyngeal carcinoma after radiotherapy were treated and nursed with routine methods. 3 cases of such diseases in Ⅰ～Ⅱ degree were controlled, 2 cases were detained gastric tube and 1 case was detained jejunal tube. The bronchoscope, tracheotomy with sac, permanent gastrectomy were performed in the patient with Ⅲ～Ⅳ degree. Results 15 cases were improved the hypoxia and reduced aspiration pneumonia. Conclusion The Ⅰ～Ⅱ degree aspiration pneumonopathy after radiotherapy in nasopharyngeal carcinoma should be treated with conservative methods and the Ⅲ～Ⅳ degree patient should be treated with surgery methods for the chronic and intractable patient and the bronchoscope should be performed earlier before surgery for the acute and severe patients.