【Aspiration Pneumonia 吸入性肺炎】

【译文】吸入性肺炎不宜作为一个单独的疾病,而应作为疾病整体的一部分,其中包括社区和医院获得性肺炎。据估计,吸入性肺炎占社区获得性肺炎的5%-15%。大量吸入口咽定植菌或上消化道内容物是吸入性肺炎的必要条件。本综述关注吸入相关的肺实质病变,主要是吸入性肺炎和化学性肺炎。鉴别吸入性肺炎与化学性肺炎仍存在挑战。吸入性肺炎由特定微生物引起肺部感染,而化学性肺炎是肺脏对刺激性胃内容物的炎症反应。诊断吸入性肺炎取决于典型的临床病史(可证实的吸入病史)、危险因素以及相应的胸片表现。影像学检查结果包括重力依赖性肺段浸润(如患者发病时处于仰卧位,则病变部位为下叶背段或上叶后段;或患者处于直立位,即为下叶基底段)。吸入性肺炎的致病菌已从厌氧菌转为需氧菌。也讨论了吸入肺炎治疗和预防策略。

【原文】 Aspiration pneumonia is best considered not as a distinct entity but as part of a continuum that also includes community- and hospital-acquired pneumonias. It is estimated that aspiration pneumonia accounts for 5 to 15% of cases of community-acquired pneumonia. Large-volume aspiration (macro-aspiration) of colonized oropharyngeal or upper gastrointestinal contents is the sine qua non of aspiration pneumonia. This review focuses on aspiration involving the lung parenchyma, primarily aspiration pneumonia and chemical pneumonitis. Challenges remain indistinguishing aspiration pneumonia from chemical pneumonias. Aspiration pneumonia is an infection caused by specific micro-organisms, whereas chemical pneumonitis is an inflammatory reaction to irritative gastric contents. The diagnosis of aspiration pneumonia depends on a characteristic clinical history (witnessed macroaspiration), risk factors, and compatible findings on chest radiography. These radiographic findings include infiltrates in gravity-dependent lung segments (superior lower-lobe or posterior upper-lobe segments, if the patient is in a supine position during the event, or basal segments of the lower lobe, if the patient is upright during the event). The caustive agents of aspiration pneumonia have shifted from anaerobic to aerobic bacteria. Treatment and prevention strategy are discussed.