老年患者胸外科手术后急性间质性肺炎5例并文献复习  

Acute interstitial pneumonia in elderly patients after thoracic surgery:a report of 5 cases and literature review

作　　者：马超[1] 黄川 田文鑫[1] Ma Chao;Huang Chuan;Tian Wenxin(Department of Thoracic Surgery,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院胸外科,国家老年医学中心,中国医学科学院老年医学研究院,北京100730

出　　处：《中华老年医学杂志》2022年第5期574-579,共6页Chinese Journal of Geriatrics

摘　　要：目的分析胸外科术后出现急性间质性肺炎老年患者的临床特点,为术后急性间质性肺炎的诊治提供依据。方法收集2014年10月至2021年10月北京医院胸外科手术的老年患者2578例,其中5例胸外科手术后出现急性间质性肺炎,分析患者的诊治过程并结合文献探讨其诊治要点。结果5例患者年龄60~74岁,其中男性4例,女性1例,3例术前合并特发性肺间质纤维化,2例术前合并干燥综合征继发肺间质纤维化,术前胸部CT影像特点为双肺散在多发小叶间隔增厚、磨玻璃影、网格影及索条影。5例患者均在术后1~3 d出现不明原因、进行性加重的呼吸困难,胸部影像均表现为在原有肺间质纤维化基础上双肺新增大片状磨玻璃影、网格影及索条影。4例使用糖皮质激素治疗,4例行气管插管、机械通气。2例治疗成功,1例治疗后好转但出现再次加重后死亡,2例治疗无效后死亡。结论合并肺间质纤维化患者胸外科手术后早期可出现进行性加重的呼吸困难,及时胸部CT和呼吸道病原学检查有助于早期鉴别诊断,急性间质性肺炎常累及双肺,病情进展迅速,病死率高。一旦进展至呼吸衰竭,应尽早行机械通气,改善脏器功能。糖皮质激素应早期、足量、足疗程使用,治疗期间应谨防病情反复。Objective To analyze the clinical characteristics of elderly patients with acute interstitial pneumonia after thoracic surgery,and to provide evidence for the diagnosis and treatment of acute interstitial pneumonia after surgery.Methods Data from 2578 elderly patients who had undergonethoracic surgery at Beijing Hospital from October 2014 to October 2021were collected.Five patients developed acute interstitial pneumonia after thoracic surgery.The diagnosis and treatment of the patients were analyzed and major relevant issues were discussed in combination with the literature.Results Of the 5 patients aged from 60 to 74 years,including 4 men and 1 woman,3 had idiopathic pulmonary interstitial fibrosis and 2 had Sjogren's syndrome with secondary pulmonary interstitial fibrosis.Preoperative chest CT images were characterized by sporadic interlobular septal thickening and ground-glass,reticular and linear opacities in both lungs.After surgery,all 5 patients presented unexplained and progressively aggravating dyspnea in 1~3 days and chest imaging showed newly emerged and more diffuse ground-glass,reticular and linear opacities in both lungs,in addition toprevious pulmonary interstitial fibrosis.Four patients were treated with glucocorticoids,and four underwent endotracheal intubation and mechanical ventilation.Two cases were treated successfully,1 case improved after treatment but died after re-aggravation,and 2 cases died after treatment failure.Conclusions Patients with pulmonary interstitial fibrosis after thoracic surgery may have progressive and aggravated dyspnea in the early postoperative period.Early CT imaging and pathogenic examinations will be helpful in differential diagnosis.Acute interstitial pneumonia often involves both lungs,with rapid progression and high mortality.Once the disease has progressed to respiratory failure,mechanical ventilation should be initiated as early as possible to improve organ function.Glucocorticoids should be used early with sufficient doses and lengths to prevent re-aggravatio

关 键 词：胸外科手术 肺疾病 间质性 呼吸功能不全 

分 类 号：R655[医药卫生—外科学] R563.1[医药卫生—临床医学]