Lipoid Pneumonia Caused by Diesel Aspiration: A Case Report and Literature Review

Diesel poisoning is a rare clinical condition.On September 27,2021,a 55-year-old male who mistakenly inhaled 20 mL of diesel through a siphon was admitted to our hospital.The main symptoms were cough and asthma.Chest computed tomography(CT)showed both lungs scattered with patchy consolidation,ground-glass shadow,exudation,and pleural effusion.After 61 days of lung rehabilitation training and other supportive treatment,including oxygen therapy,postural drainage,ventilator support,bronchoalveolar lavage,hemoperfusion,continuous renal replacement therapy(CRRT),hormones,and antibiotics,the patient’s condition improved,and the patient was discharged.Through literature review,we found that lung consolidation,ground-glass shadow,nodular lesions,and pleural effusion can be observed on chest images of patients with lipoid pneumonia,with severe cases showing diffuse lesions involving both lungs,possibly secondary to respiratory failure.Children with acute critical illness deteriorates rapidly and have poor prognosis,whereas adults or patients with chronic poisoning have better prognosis after active treatment.

Capacity of the Pectoralis Major Muscle May Be a Prognostic Factor for Aspiration Pneumonia

Objective: Aspiration pneumonia is thought to be caused by a decline in respiratory and swallowing function. We aimed to clarify whether the pectoralis major muscle and the rectus abdominis muscles are prognostic factors for aspiration pneumonia and to investigate the relationships between these muscles and nutritional status, swallowing function and sarcopenia, Methods: Medical records of 139 Japanese patients hospitalized for aspiration pneumonia between December 2010 and December 2014 were reviewed retrospectively. The volume and thickness of the pectoralis major muscle, the crosssectional area and thickness of the rectus abdominis muscles, and cross-sectional area of the psoas major muscle were measured using computed tomography. Swallowing function, nutritional status, activities of daily living, and prognosis also were evaluated. Results: The volume [Median: (left) 4713.2 mm3 vs. 4232.6 mm3 (right) 4981.7 mm3 vs. 4362.6 mm3 p < 0.05] and thickness [Median: (left) 6.9 mm vs. 4.6 mm (right) 7.3 mm vs. 5.7 mm p < 0.01] of the pectoralis major muscle and thickness of the right rectus abdominis muscles [Median: 7.3 mm vs. 5.8 mm p < 0.05] were significantly larger, while Mini-Nutritional Assessment Short Form (MNA-SF) [Median: 6.0 vs. 4.0 p < 0.01] and Functional Oral Intake Scale (FOIS) [Median: 3 vs. 1 p < 0.01] scores were significantly higher in patients who survived. The volume [Median: (left) 5789.1 mm3 vs. 3706.5 mm3 (right) 5650.3 mm3 vs. 4003.7 mm3 p < 0.01] and thickness [Median: (left) 7.1 mm vs. 5.9 mm p < 0.05] of the pectoralis major muscle and cross-sectional area of the psoas major muscle (left and right) [Median: (left) 500.1 mm2 vs. 432.0 mm2 (right) 563.5 mm2 vs. 446.3 mm2 p < 0.01] were significantly larger, while albumin levels [Median: 3.8 g/dl vs. 3.4g/dl p < 0.01] and MNA-SF [Median: 6.0 vs. 5.0 p < 0.01] and FOIS [Median: 4 vs. 1 p < 0.01] scores were significantly higher in patients with coexisting diseases. Conclusion: The capacity of the pectoralis major muscle may be an independent factor in the prognosis of elderly patients with aspiration pneumonia as a primary disease.

Aspiration pneumonia during general anesthesia induction after esophagectomy: A case report

BACKGROUND Esophageal cancer is a common malignant tumor of the digestive system.At present,surgery is the most important treatment strategy.After esophagectomy and gastric esophagoplasty,the patients are prone to regurgitation.However,these patients currently do not receive much attention,especially from anesthesiologists.CASE SUMMARY A 55-year-old woman was scheduled for right lower lung lobectomy.The patient had undergone radical surgery for esophageal cancer under general anesthesia 6 mo prior.Although the patient had fasted for>17 h,unexpected aspiration still occurred during induction of general anesthesia.Throughout the operation,oxygen saturation was 98%-100%,but the airway pressure was high(35 cmH2O at double lung ventilation).The patient was sent to the intensive care unit after surgery.Bedside chest radiography was performed,which showed exudative lesions in both lungs compared with the preoperative image.After surgery,antibiotics were given to prevent lung infection.On day 2 in the intensive care unit,the patient was extubated and discharged on postoperative day 7 without complications related to aspiration pneumonia.CONCLUSION After esophagectomy,patients are prone to regurgitation.We recommend nasogastric tube placement followed by rapid sequence induction or conscious intubation.

Effects of Semi-Solid Enteral Formula on Aspiration Pneumonia and Diarrhea

Objective: The effects of semi-solid enteral formula were investigated in tube feeding patients with aspiration pneumonia and/or diarrhea caused by liquid enteral formula. Methods: In 25 cases of aspiration pneumonia and 10 cases of diarrhea (5 cases had both aspiration pneumonia and diarrhea) caused by liquid enteral formula, the rate of improvement by changing the liquid enteral formula to semi-solid enteral formula was studied. The semi-solid enteral formula (PG Soft&reg;EJ) was infused via the nasogastric tube (16Fr) or percutaneous endoscopic gastrostomy (PEG) tube (20Fr). Results: The semi-solid enteral formula was effective in 72% of aspiration pneumonia cases and in 80% of diarrhea cases. Constipation was observed in one case but was controlled with magnesium oxide. Conclusion: In cases of aspiration pneumonia and/or diarrhea, changing liquid enteral formula to semi-solid enteral formula frequently shows improvement.

Effect of Feeding Management on Aspiration Pneumonia in Elderly Patients with Dysphagia

Objective： To investigate the effects of feeding safety instructions and dietary intervention on aspiration pneumonia in elderly patients with dysphagia. Methods： The study included 40 long-term hospitalized elderly patients with dysphagia who needed oral intake, According to the voluntary and matching principle, participants were divided into the intervention group （n =20） and control group （n = 20）. We formed a multi-disciplinary team including clinical nurses, rehabilitation therapists and nutritionists. Clinical nurses collaborated with nutritionists and rehabilitation therapists to carry out feeding management. The patients in the control group were fed with semi-solid food, thick liquid, a partial mushy diet and so on according to their swallowing situations and tastes or preferences. The patients in the intervention group were fed with an all mushy diet. Patients in both groups were able to eat foods on their own or with assistance. Results： After a three-month intervention, the incidence of aspiration pneumonia in both groups was decreased, and the difference was statistically significant （P〈0.05）. In the control group, seven patients had aspiration pneumonia, including two cases who died after nasogastric feeding due to aggravated dysphagia. In the control group, seven patients had aspiration pneumonia, including two cases was given nasogastric feeding due to aggravated dysphagia and then one case died. In the intervention group, four patients had aspiration pneumonia. There was no dropouts in either group. Conclusions： Elderly patients with dysphagia require a multidisciplinary team to work closely with them to carry out feeding management. Nurses should conduct safety guidance for care catering and encouraging patients to actively eat a mushy diet. The diet can reduce the incidence of aspiration pneumonia, maintain oral intake and improve the quality of life.

Multidisciplinary approach to suspected sudden unexpected infant death caused by milk-aspiration:A case report

BACKGROUND The term sudden unexpected infant death(SUID)is not always properly invoked.It refers to a broad range of conditions that sometimes defy classification.There is not only a strong emotional impact on the family,but such cases are also quite complex.Underlying causes may be multiple,not always readily apparent,and have potential repercussions,especially in terms of forensics.CASE SUMMARY A 5-month-old male baby was pronounced dead following acute lung failure and cardiopulmonary arrest.The parents had immediately rushed their child to the hospital,stating the baby was found prone and not breathing.Total-body postmortem computed tomography(PMCT)was performed,revealing a hypodense material of indeterminate nature within the main airways and areas of ground-glass parenchymal change.At autopsy,the respiratory tract mucosa appeared edematous and was coated with a whitish stringy material.There was widespread airspace reduction due to parenchymal collapse.Alveolar sacs and bronchial openings contained abundant amorphous material admixed with white blood cells.Immunohistochemical studies were performed,targeting CD15,CD68,and alpha-lactalbumin.Ultimately,the focus was on alpha-lactalbumin(milk protein),which showed marked immunopositivity within alveolar spaces.Cytoplasmic staining of macrophages was also particularly prominent.CONCLUSION Postmortem investigations are thus essential to identify causes of death and surrounding circumstances.PMCT is a useful tool in this setting,given the frequent dearth of autopsy findings and ambiguity as to cause of death in SUID cases.These findings,later confirmed by immunohistochemical investigations,were indicative of active pneumonia due to aspirated milk.The present account illustrates the importance a broad diagnostic approach to SUID in cases of forensic concern.PMCT is a very valuable aid in cases of forensic interest,as it can provide useful information in all those situations in which the cause of death is uncertain or there are no suggestive dynamics or lesions.

AIS-APS评分对缺血性脑卒中病人卒中相关性肺炎预测价值的Meta分析

目的:系统评价急性缺血性脑卒中相关性肺炎评分(AIS-APS)评分对缺血性脑卒中病人卒中相关性肺炎(SAP)的预测价值。方法:检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、PubMed、Web of Science、EMbase、the Cochrane Library、Wiley等数据库关于使用AIS-APS评分预测缺血性脑卒中发生SAP风险的相关文献,检索时限为建库至2023年5月31日。采用诊断准确性研究质量评估工具(QUADAS-2)进行文献质量评价,运用Stata 17.0软件进行Meta分析。结果:最终纳入14篇文献进行Meta分析,涉及7117例病人。Meta分析结果显示,AIS-APS预测缺血性脑卒中病人发生SAP风险合并灵敏度为0.82[95%CI(0.74,0.88)],合并特异度为0.73[95%CI(0.66,0.80)],合并阳性似然比为3.08[95%CI(2.53,3.76)],合并阴性似然比为0.25[95%CI(0.18,0.34)],合并DOR为2.52[95%CI(2.20,2.84)],合并优势比为12.40[95%CI(9.01,17.06)]。AIS-APS预测缺血性脑卒中SAP的综合受试者工作特征曲线(SROC)的曲线下面积(AUC)为0.84[95%CI(0.81,0.87)]。Deek′s漏斗图分析显示,纳入文献无发表偏倚(P=0.73),范根图显示该评分在临床适用性良好。结论:现有证据表明,AIS-APS评分对缺血性脑卒中病人发生SAP风险具有一定的预测价值,可对临床病人进行初步筛查,识别发生SAP高风险病人,以便做出进一步的预防与治疗。

麻杏解毒合剂通过p38MAPK/AP-1通路对冠状病毒肺炎模型小鼠炎性因子的调控作用研究

目的研究麻杏解毒合剂对冠状病毒肺炎模型小鼠炎性因子表达的影响,基于p38MAPK/AP-1通路研究其疗效机制。方法60只昆明种(KM)小鼠随机分成空白对照组、模型组、p38MAPK抑制剂组及麻杏解毒合剂高、中、低剂量组,每组10只。采用模拟寒湿环境、表达h ACE2的重组腺相关病毒转导、SARS-CoV-2spike假病毒气管内给药建立小鼠冠状病毒肺炎模型。检测各组小鼠血清炎性因子、肺组织病理改变、肺组织p38MAPK、c-jun、c-fos的mRNA水平和蛋白表达情况。结果与空白对照组比较,模型组小鼠血清炎性因子白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)的表达均显著升高(P<0.01),肺组织炎性改变明显,c-fos m RNA水平和p-p38、c-fos、c-jun蛋白表达均显著增加(P<0.05)。与模型组比较,麻杏解毒合剂高、中剂量组小鼠血清炎性因子显著降低(P<0.01或P<0.05),小鼠肺组织炎性损伤明显减轻,同时肺组织中c-fos的mRNA水平和p-p38、c-fos的蛋白表达均显著下调(P<0.05)。结论麻杏解毒合剂能降低病毒性肺炎模型小鼠血清炎性因子水平,减轻肺组织炎性损伤,其疗效机制与抑制p38MAPK蛋白的磷酸化,下调AP-1通路mRNA及蛋白表达有关。

Severe aspiration pneumonia in the elderly

The global population is aging at an unprecedented rate,resulting in a growing and vulnerable elderly population in need of efficient comprehensive healthcare services that include long-term care and skilled nursing facilities.In this context,severe aspiration pneumonia,a condition that carries substantial morbidity,mortality,and financial burden,especially among elderly patients requiring admission to the intensive care unit,has attracted greater concern.Aspiration pneumonia is defined as a pulmonary infection related to aspiration or dysphagia in etiology.Prior episodes of coughing on food or liquid intake,a history of relevant underlying conditions,abnormalities on videofluoroscopy or water swallowing,and gravity-dependent shadow distribution on chest imaging are among the clues that suggest aspiration.Patients with aspiration pneumonia tend to be elderly,frail,and suffering from more comorbidities than those without this condition.Here,we comprehensively address the epidemiology,clinical characteristics,diagnosis,treatment,prevention,and prognosis of severe aspiration community-acquired pneumonia in the elderly to optimize care of this high-risk demographic,enhance outcomes,and minimize the healthcare costs associated with this illness.Emphasizing preventive measures and effective management strategies is vital in ensuring the well-being of our aging population.

鼻肠管及鼻胃管的营养干预护理对脑血管意外患者发生吸入性肺炎并发症及睡眠质量的影响

目的:探讨研究脑血管意外患者用鼻肠管营养干预效果。方法:选取2021年4月至2022年4月厦门大学附属第一医院神经内科收治的脑血管意外患者100例作为研究对象,按照随机数字表法分为对照组和观察组,每组50例。2组患者均予以常规护理,对照组给予常规鼻胃管营养干预,观察组给予鼻肠管营养干预。比较2组患者的吸入性肺炎发生率、睡眠质量评分及营养状况。结果:观察组吸入性肺炎发生率低于对照组,差异有统计学意义(P<0.05);观察组入睡潜伏期、PSQI评分低于对照组,实际睡眠时长高于对照组,差异有统计学意义(P<0.05);观察组血红蛋白(Hb)、血清白蛋白(Alb)、血清总蛋白(TP)均高于对照组,差异有统计学意义(P<0.05)。结论:鼻肠管营养干预护理可降低脑血管意外患者吸入性肺炎发生率,改善患者睡眠质量及营养状况,值得临床推广应用。

注射用乌司他丁联合纤维支气管镜吸痰治疗重症肺炎的疗效及对患者血清sTREM-1、sCD163的影响

目的:探究注射用乌司他丁联合纤维支气管镜吸痰治疗重症肺炎的疗效及对患者血清sTREM-1、sCD163的影响。方法:选取2020年6月至2023年6月滨州医学院附属医院收治的重症肺炎患者为研究对象。将符合排纳标准的92例重症肺炎患者随机分为对照组(n=46)和联合组(n=46)。对照组在常规治疗基础上行纤维支气管镜吸痰,联合组在对照组的基础上加用乌司他丁。观察两组患者的炎性因子水平(PCT、TNF-α、CRP)及sTREM-1、sCD163水平、血气分析指标(血氧分压和氧合指数)、临床疗效。结果:(1)治疗前,两组炎性因子水平对比(P>0.05),治疗后,联合组的炎性因子水平(TNF-α、CRP、PCT)均低于对照组(P<0.05)。(2)治疗前,两组血清sTREM-1、sCDl63水平对比(P>0.05),治疗后,联合组的血清sTREM-1、sCDl63水平均低于对照组(P<0.05)。(3)治疗前,两组血氧分压、氧合指数对比(P>0.05),治疗后,联合组的血氧分压、氧合指数均低于对照组(P<0.05)。(4)联合组的有效率为95.65%高于对照组的82.61%(P<0.05)。结论:注射用乌司他丁联合纤维支气管镜吸痰可有效改善重症肺炎患者的炎性因子水平、血气分析指标、临床疗效。

早期摄食训练监测在缺血性脑卒中伴吞咽障碍病人中的应用

目的:探究早期摄食训练监测在缺血性脑卒中伴吞咽障碍病人中的应用效果。方法:选取2022年2月—2023年3月在长春市某三级甲等医院脑病中心住院接受治疗的缺血性脑卒中伴吞咽障碍病人126例为研究对象,采用随机数字表法将病人分为两组,对照组63例,干预组63例。对照组给予常规康复训练护理方案,干预组在对照组基础上实施早期摄食训练监测。比较两组吞咽功能等级、吞咽功能恢复情况、口咽性吞咽障碍、误吸及吸入性肺炎发生率、住院天数、胃管拔除后再插管率。结果:干预组吞咽功能等级低于对照组,总有效率高于对照组(P<0.05);干预组误吸发生率为3.17%,对照组为25.40%,干预组低于对照(P<0.05);干预组吸入性肺炎发生率为6.35%,对照组吸入性肺炎发生率为20.63%,干预组低于对照(P<0.05);干预组口咽性吞咽障碍情况优于对照组(P<0.05)。结论:早期摄食训练监测对于改善缺血性脑卒中伴吞咽障碍病人吞咽功能、降低病人误吸及吸入性肺炎发生率具有积极意义。

脑卒中患者隐性误吸风险管理研究进展

从脑卒中患者发生隐性误吸的风险因素(年龄、吞咽障碍、意识障碍、疾病与治疗性因素、机械通气、气管插管与气管切开、照护因素)、不良结局(吸入性肺炎、营养不良与恐惧)及防范措施(吞咽功能康复训练、营养管理、集束化护理、知识与技能培训)三方面进行综合论述,旨在为护理人员更好地护理脑卒中患者、预防隐性误吸提供参考。

间歇经口至食管管饲法对脑卒中吞咽障碍患者病耻感和吸入性肺炎的影响

目的探讨间歇经口至食管管饲法(IOE)对脑卒中后吞咽障碍(PSD)患者的病耻感和吸入性肺炎(AP)的影响。方法选取2021年1月至2023年6月芜湖市第一人民医院收治的52例脑卒中患者作为研究对象,按照随机数字表法将入组患者分为IOE组(26例)与留置鼻胃管法(CNG)组(26例)。IOE组采取经口至食管管饲法进食,CNG组则采取留置胃管法进食,两组患者均同时进行常规康复治疗。比较两组患者在入院后1周、治疗30 d时脑卒中患者病耻感量表(SSS)评分及AP发生率。结果IOE组治疗30 d时SSS量表分值低于CNG组,差异有统计学意义(P<0.05)。IOE组住院期间AP发生率低于CNG组,差异有统计学意义(P<0.05)。结论IOE法能够有效降低脑卒中吞咽障碍患者的病耻感及降低住院期间AP发生率。

急性缺血性脑卒中患者住院期间吸入性肺炎风险评分构建与验证

目的 探讨急性缺血性脑卒中(AIS)患者住院期间发生吸入性肺炎的危险因素,并构建AIS患者住院期间发生吸入性肺炎风险的预测模型。方法 收集温州医科大学附属第二医院因AIS入院患者的临床资料。用单因素、多因素Logistic回归分析,筛选出发生吸入性肺炎的相关危险因素,并构建预测模型。结果 高龄、入院时GCS评分低、既往卒中病史、糖尿病史、吞咽障碍及低白蛋白血症是AIS患者住院期间并发吸入性肺炎危险因素。该模型预测吸入性肺炎发生风险的ROC曲线下面积(AUC)为0.831(0.786~0.876),内部验证预测吸入性肺炎发生风险的AUC为0.827(0.782~0.873)。Hosmer-Lemeshow检验:χ^(2)=12.585,P=0.127。结论 本预测模型具有良好的区分度与校准度,有助于临床医师评估AIS中患者住院期间发生吸入性肺炎风险。

自由饮水训练在吞咽障碍患者中应用的研究进展

文章对自由饮水训练的概念、适用人群、训练原则和方法以及自由饮水在吞咽障碍患者中的应用效果等进行了综述,以期为自由饮水训练在吞咽康复领域的研究提供参考.

成人危重症患者误吸预防与管理的最佳证据总结

目的 系统检索、评价及整合成人危重症患者误吸预防与管理的相关证据,并汇总形成最佳证据,为误吸的预防与管理提供依据。方法 遵照“6S”金字塔模型,自上而下系统检索BMJ Best Practice,UpToDate,澳大利亚乔安娜布里格斯研究所循证卫生保健中心数据库,加拿大安大略省注册护士协会,国际指南协作网,美国指南网,英国国家卫生与临床优化研究所,苏格兰校际指南网,PubMed,Embase,Cochrane Library,CINAHL,中国临床指南文库,医脉通,中国生物医学文献数据库,中国知网,万方数据库和维普数据库。纳入有关危重症患者误吸预防与管理的临床决策、指南、证据总结、专家共识/专家推荐、系统评价/Meta分析、随机对照试验,检索时限为2013年1月至2023年8月。由2名接受过循证护理学培训的研究者独立进行文献筛选、质量评价、证据提取与整合。结果 共纳入33篇研究,包括临床决策4篇、指南4篇、证据总结5篇、专家共识8篇、系统评价/Meta分析9篇、随机对照试验3篇。涉及误吸风险评估、气道管理、口腔卫生管理、体位管理、肠内营养管理、药物管理与干预、拔管后误吸的预防、误吸的诊断与处理、误吸培训与团队管理9个方面,共36条证据。结论 该证据总结可为医护人员对危重症患者误吸的预防及管理工作提供循证依据,促进ICU误吸的科学、规范化管理。

肺炎衣原体感染和高脂血症对心肌细胞NF-kappa B和AP-1的影响

目的:探讨肺炎衣原体感染和高脂血症对心肌细胞炎症的影响。方法:用间接免疫荧光的方法检测肺炎衣原体感染或给予高脂饮食的C57BL/6J小鼠,观察NF-κB亚单位P50和c-Fos在小鼠心肌细胞中表达程度。结果:肺炎衣原体感染和高脂血症能引起心肌细胞中P50和c-Fos的激活。对照组心肌细胞核中未见P50和c-Fos的表达,而3个实验组心肌细胞核中都有不同程度的P50和c-Fos表达。实验组和对照组比较P<0.01,在3个实验组间无显著差异。结论:在肺炎衣原体感染和高脂血症形成的早期,心肌细胞的炎症通路已被激活。

常规吸痰联合定期床旁纤维支气管镜下吸痰治疗重症肺炎机械通气患者的效果评价

目的:探讨常规吸痰联合定期床旁纤维支气管镜下吸痰治疗重症肺炎机械通气患者的效果。方法:选取2020年6月—2022年6月思南县人民医院收治的82例重症肺炎机械通气患者。根据随机数表法将其分为对照组和观察组,各41例。对照组给予常规吸痰,观察组在对照组基础上给予定期床旁纤维支气管镜下吸痰。比较两组治疗后临床疗效,治疗前及治疗2周后血气分析指标、相关指标及恢复情况。结果:观察组总有效率高于对照组,差异有统计学意义(P<0.05)。治疗2周后,观察组血氧分压(PaO_(2))高于对照组,二氧化碳分压(PaCO_(2))低于对照组,差异有统计学意义(P<0.05)。治疗2周后,观察组氧浓度(FiO_(2))、呼气末正压(PEEP)均低于对照组,氧合指数(PaO_(2)/FiO_(2))高于对照组,差异有统计学意义(P<0.05)。观察组抗菌药物应用时间、肺部炎症吸收时间、机械通气时间及住院时间均短于对照组,差异有统计学意义(P<0.05)。结论:定期床旁纤维支气管镜下吸痰联合常规吸痰可提高重症肺炎机械通气患者疗效,纠正血气分析指标异常,促进肺部炎症吸收,缩短抗菌药物应用及住院时间。

老年吸入性肺炎住院患者的综合管理

吸入性肺炎是导致老年住院患者住院时间延长、反复住院、进展为重症甚至死亡的重要原因之一。老年吸入性肺炎发生的高危因素以及影响预后的因素均是复杂多变的,给诊断和医疗照护带来了巨大挑战。本文通过文献回顾,对近10年国内外老年吸入性肺炎住院患者的综合管理方面的研究进展进行总结和分析,包括吞咽评估及管理、老年综合评估、多学科团队干预、动态随访等,并结合临床实践探讨适合我国国情的有效管理措施。