食管裂孔疝患者行无痛胃镜检查并发肺炎5例并文献复习

Five cases of hiatal hernia complicated with pneumonia during painless gastroscopy and literature review

目的探讨食管裂孔疝患者行无痛胃镜检查并发肺炎的诊疗及预防措施。方法选取2021年11月至2023年2月青岛大学附属威海市立第二医院收治的行无痛胃镜检查并发肺炎的食管裂孔疝患者5例,回顾性分析其临床特点、诊治过程,并复习相关文献。结果5例患者中有4例在进镜过程中发现食管中有液体潴留。5例患者均发热,其他表现有咳嗽、咳痰、畏寒等;白细胞总数或者中性粒细胞比例均升高;胸部CT均显示左肺炎症。5例患者中,4例术中给予吸氧及静脉应用地塞米松;4例给予左氧氟沙星抗感染,1例给予头孢唑肟钠抗感染治疗。5例患者体温均于48 h内恢复正常,4例经CT复查显示病灶吸收,1例患者CT随访发现左肺出现厚壁空洞,经延长抗感染治疗后空洞消失,病灶吸收。结论食管裂孔疝患者行无痛胃镜检查并发肺炎应在临床上高度重视并积极采取防治措施。

Objective To investigate the treatment and prevention measures of hiatal hernia complicated with pneumonia during painless gastroscopy.Methods A total of 5 patients with hiatus hernia complicated with pneumonia undergoing painless gastroscopy during Nov.2021 and Feb.2023 were involved.The clinical characteristics,diagnosis and treatment were analyzed,and relevant literature was reviewed.Results Residual fluid in the esophagus was found in 4 out of 5 patients during the insertion of the gastroscope;all 5 patients had fever,cough,excessive phlegm and chills.The total number of white blood cells or the proportion of neutrophils were increased in all patients.CT showed that all patients had left lung pneumonia.Four patients were given oxygen inhalation and intravenous dexamethasone during gastroscopy;four patients were given levofloxacin,and one was given ceftizoxime sodium for anti-infection.The body temperature of all patients returned to normal within 48 hours;re-examination of lung CT suggested lesion absorption in 4 patients;CT follow-up of the other patient revealed a thick-walled cavity in the left lung,which disappeared after prolonged anti-infective therapy.Conclusion Pneumonia is a serious complication in patients with hiatal hernia during painless gastroscopy.Due attention should be paid and active prevention measures should be adopted.