油脂吸入性肺炎16例临床特征分析

Clinical characteristics of lipid aspiration pneumonia in 16 children

目的 探讨儿童油脂吸入性肺炎的临床特点及影像学表现.方法 对2003年1月至2013年7月温州医科大学附属育英儿童医院收治的住院确诊的16例油脂吸入性肺炎患儿的临床资料、影像学特点及治疗、转归进行回顾性分析.结果 16例患儿均有明确的矿物油误服史.4例无任何临床表现;10例出现发热,其中8例于误服矿物油后4～8h内出现,体温均39.0 ～ 40℃;12例有症状患儿在误服30 min内出现喘息2例,气促6例,发绀l例,呼吸困难3例,呻吟不安2例;伴发胸痛l例,头痛伴脑电图异常1例;体格检查闻及肺部哕音6例.血常规示白细胞增多10例,C-反应蛋白升高7例.6例患儿于误服后24 h内行胸部CT检查均发现异常,最早见于误服后2 h;9例行胸部X线片均发现异常,最早见于误服后3h;1例于误服后2～3h胸部X线片未见异常,3d后复查异常.所有患儿均接受糖皮质激素及抗生素治疗,4例接受了肺泡灌洗,3例输注白蛋白针,6例输注丙种球蛋白针.其中有3例患儿诊断及激素治疗延误,出现病情加重,2例明确继发感染.最终12例患儿肺部达到基本或完全吸收,历时8d～5.5个月.结论 儿童油脂吸入性肺炎多见于误服矿物油后.大多数患儿在吸入24h内均能出现肺部影像学改变,早期行胸部CT检查有助于诊断.激素治疗能加快病变吸收.

Objective To investigate clinical characteristics and changes of pulmonary imaging of mineral oil aspiration pneumonia in children.Method The clinical features,CT findings,and effects of corticosteroid therapy were analyzed in 16 children with mineral oil aspiration pneumonia,who were hospitalized in our hospital from January 2003 to July 2013.Result All patients with mineral oil aspiration pneumonia had a history of mineral oil administration.Four patients had no clinical manifestations.Ten cases presented fever,and 8 of the 10 patients had fever in 4-8 h after taking mineral oil,and the temperature was between 39-40 ℃.There were wheezing in 2 cases,shortness of breath in 6 cases,cyanosis in 1 case,dyspnea in 3 cases,and moaning in 2 cases,chest pain in 1 case,headache and abnormal EEG in 1 case.Six patients had rales in lungs.Peripheral blood white cells increased in 10 cases,and C-reactive protein elevated in 7 patients.Chest CT examination showed abnormal findings in 6 children,and the earliest CT was performed within 2 h after the accident.The rest 10 children got chest X-ray,and 9 of 10 children had abnormal findings.The earliest X-ray was done within 3 h after the accident.And the remaining 1 of 10 children showed no significant changes in the first chest X-ray 2-3 h after the accident until 3 days.All of the patients received corticosteroid and antibiotic treatments,4 cases underwent bronchoalveolar lavage,3 patients were given albumin,6 cases received intravenous immunoglobulin.Three cases delayed in treatment with hormone because of misdiagnosis,and 2 of them had clearly secondary infections.Twelve patients recovered completely from oil aspiration pneumonia after 8 days to 5.5 months.Conclusion Oil aspiration pneumonia in children occurs in almost all cases after mineral oil aspiration.Pulmonary opacities can be found by chest CT in most patients within 24 hours after mineral oil aspiration.Corticosteroids therapy was effective for patients with exogenous lipid pneumonia,which may inhibit the inflammatory response and possible pulmonary fibrosis.