鼻咽部分泌物误吸的检测及其与老年肺炎发病的关系

Detection of aspiration of nasopharyngeal secretion and the relationship between the aspiration of nasopharyngeal secretion and the incidence of pneumonia

目的 探讨鼻咽部分泌物误吸的检测方法及其与肺炎发病的关系.方法 纳入2014年6-8月入住广州医科大学附属第一医院呼吸内科的32例肺炎患者,男30例,女2例,年龄56～ 86岁,平均（73±8）岁.对照组为同期健康体检志愿者9名,男7名,女2名,年龄64 ～ 80岁,平均（73 ±6）岁.将74.0 MBq 99Tcm-硫胶体溶解于12 ml生理盐水中,通过鼻咽管以24 ml/h的恒速滴入受试者鼻咽部,用SPECT/CT动态采集口腔至胃部的后前位图像.由2位核医学科主治医生读片,左和（或）右主支气管及分支以下部位出现放射性显影为误吸试验阳性.结果 32例肺炎患者中,19例伴随鼻塞、流涕等上呼吸道分泌物增多症状,其中误吸试验阳性21例;9名健康对照者未发现误吸,两组差异有统计学意义（x2=9.624,P=0.002）;21例误吸试验阳性的肺炎患者中,双肺（6/10）、右肺（6/8）和左肺（2/3）肺炎患者同时发生相应部位核素显像阳性的14例,肺炎发生部位和核素显像阳性部位相符（P=0.067）.结论 99Tcm-硫胶体可检测老年人鼻咽部分泌物所导致的误吸.肺炎患者鼻咽分泌物误吸的发生率较高,提示感冒后鼻咽分泌物误吸与肺炎的发病有关.

Objective To establish a method to detect aspiration of nasopharyngeal secretion and to explore the relationship between aspiration of nasopharyngeal secretion and pneumonia.Method Thirty-two patients with pulmonary infection [（30 males,2 females;mean age （73 ±8）years] were recruited from the First Affiliated Hospital of Guangzhou Medical University during the period between June 2014 and August 2014,and 9 age-matched healthy volunteers [（7 males,2 females;mean age （73 ± 6） years] as the control group.A dose of 74.0 MBq 99Tcm-sulfur colloid was diluted in 12 ml of saline,and then the mixture was dripped into the nasal pharynx of volunteers by 24 ml/h.Dynamic imaging from the mouth to the stomach was acquired by SPECT/CT.Two experienced physicians assessed all examination results and reached consensus for final diagnosis.Radioactivity detected at either the bronchi or within the lung fields was reported as positive for aspiration.Results In the test group,19 of 32 patients with pneumonia had a history of suffering from upper respiratory tract symptoms such as runny or blocked nose,and 21 of 32 patients were detected to have aspiration.However,none of the healthy people had aspiration （x2 =9.624,P =0.002）.In 21 patients with pneumonia,14 showed respiratory aspirations in areas corresponding to the lesions,i.e.bilateral lungs,the right lung and the left lung in 6/10,6/8,and 2/3 cases respectively（P =0.067）.Conclusion 99 Tcm-sulfur colloid imaging is effective to detect the aspiration of nasopharyngeal secretions in the elderly people.Besides,the incidence rate of aspiration in the patients was higher than that in healthy people,which suggests that aspiration of nasopharyngeal secretion is the cause of pulmonary infection.