• 上海市華東醫(yī)院呼吸內(nèi)科( 上海 200040);

吸人性肺炎是指口咽部分泌物和胃內(nèi)容物反流吸入至喉部和下呼吸道, 引起的多種肺部綜合征, 吸入量較大時(shí)可引起急性化學(xué)性吸入性肺炎, 如果吸入量小且將咽部寄植菌
帶入肺內(nèi), 可導(dǎo)致細(xì)菌性吸入性肺炎, 常見于老年人、患有神經(jīng)系統(tǒng)疾病或腦血管病的患者, 是導(dǎo)致老年人死亡的主要危險(xiǎn)因素。其他吸入綜合征包括氣道阻塞、肺膿腫、外源性類脂質(zhì)綜合征、慢性間質(zhì)性肺炎和偶發(fā)分枝桿菌性肺炎等?，F(xiàn)將細(xì)菌性吸入性肺炎( 簡稱吸入性肺炎) 的研究進(jìn)展綜述如下。

引用本文： 范志強(qiáng),瞿介明,朱惠莉. 吸入性肺炎的研究進(jìn)展. 中國呼吸與危重監(jiān)護(hù)雜志, 2010, 9(2): 209-212. doi: 復(fù)制

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1. McClave SA, DeMeo MT, DeLegge MH, et al. North American Summit on Aspiration in the Critically ill Patient: consensus statement. J Parenter Enteral Nutr, 2002, 26: S80 -S85.
2. Shariatzadeh MR, Huang JQ, Marrie TJ. Differences in the features of aspiration pneumonia according to site of acquisition: community or continuing care facility. J Am Geriatr Soc , 2006 , 54: 296 -302.
3. Schaller BJ, Graf R, Jacobs AH. Pathophysiological changes of the gastrointestinal tract in ischemic stroke. Am J Gasroenterol, 2006 ,101: 1655-1665.
4. Doggett DL, Tappe KA, Mitchell MD, et al. Prevention of pneumonia in elderly stroke patients by systematic diagnosis and treatment of dysphagia: an evidence-based comprehensive analysis of the literature. Dysphagia, 2001, 16: 279-295.
5. Teramoto S, Yamamoto H, Yamaguchi Y, et al. A novel diagnostic test for the risk of aspiration pneumonia in the elderly. Chest, 2004 ,125: 801-802.
6. Pikus L, Levine MS, Yang YX, et al. Videofluoroscopic studies of swallowing dysfunction and the relative risk of pneumonia. Am J Roentgenol, 2003, 180: 1613-1616.
7. TerréR, Mearin F. Oropharyngeal dysphagia after the acute phase of stroke: predictors of aspiration. Neurogastroenterol Motil, 2006 ,18: 200-205.
8. Martino R, Foley N, Bhogal S, et al. Dysphagia after stroke incidence, diagnosis, and pulmonary complications. Stroke, 2005 ,36: 2756-2763.
9. Nakajoh K, Nakagawa T, Sekizawa K, et al. Relation between incidence of pneumonia and protective reflexes in post-stroke patients with oral or tube feeding. J Intern Med, 2000, 247: 39-42.
10. Katsumata U, Sekizawa K, Ebihara T, et al. Aging effects on cough reflex. Chest, 1995, 107: 290 -291.
11. Smith Hammond CA, Goldstein LB, Zajac DJ, et al. Assessment of aspiration risk in stroke patients with quantification of voluntary cough. Neurology, 2001 , 56 : 502-506.
12. Addington WR, Stephens RE, Gilliland KA. Assessing the laryngeal cough reflex and risk of developing pneumonia after stroke: an interhospital comparison. Stroke, 1999, 30: 1203 -1207 .
13. Tzeng AC, Bach JR. Prevention of pulmonary morbidity for patients with neuromuscular disease. Chest, 2000, 118: 1390 -1396 .
14. Mansel JK, Norman JR. Respiratory complications and management of spinal cord injuries. Chest, 1990, 97: 1446-1452.
15. Higenbottam T, Jackson M, Woolman P, et al. The cough response to ultrasonically nebulized distilled water in heart-lung transplantation patients. Am Rev Respir Dis, 1989, 140: 58 -61.
16. Ebihara S, Saito H, Kanda A, et al. Impaired efficacy of cough in patients with parkinson disease. Chest, 2003, 124 : 1009 -1015 .
17. Parameswaran K, Anvari M, Efthimiadia A, et al. Lipid-laden macrophages in induced sputumare a marker of oropharyngeal reflux and possible gastric aspiration. Eur Respir J, 2000, 16: 1119 -1122 .
18. Adams R, Ruffin R, Campbell D. The value of the lipid-laden macrophage index in the assessment of aspiration pneumonia. Aust N Z J Med, 1997, 27 : 550-553.
19. Farrell S, McMaster C, Gibson D, et al. Pepsin in bronchoalveolar lavage fluid: a specific and sensitive method of diagnosing gastrooesophageal reflux-related pulmonary aspiration. J Pediatr Surg,2006, 41: 289-293.
20. Metheny NA, Clouse RE, Chang YH, et al. Tracheobronchial aspiration of gastric contents in critically ill tube-fed patients:frequency, outcomes and risk factors. Crit Care Med, 2006 , 34 :1007-1015.
21. Clayton J, Ryall C. Tracheal pH monitoring and aspiration in acute stroke. Age Ageing, 2006 , 35: 47-53.
22. GIbson G, Barrett E. The role of salivary function on orophayngeal colonization. Spec Care Dentist, 1992, 12: 153-156 .
23. Palmer LB, Albulak K, Fields S, et al. Oral clearance and pathogenic oropharyngeal colonization in the elderly. Am J Respir Crit Care Med, 2001, 164: 464 -468.
24. Sumi Y,Miura H, Michiwaki Y, et al. Colonization of dental plaque by respiratory pathogens in dependent elderly. Arch Gerontol Geriatr, 2007, 44: 119 -124.
25. Russell SL, Boylan RJ, Kaslick RS, et al. Respiratory pathogen colonization of the dental plaque of institutionalized elders. Spec Care Dentist, 1999, 19: 128-134.
26. Segal R, Pogoreliuk I, Dan M, et al. Gastric microbiota in elderly patients fed via nasogastric tubes for prolonged periods. J Hosp Infect, 2006, 63: 79 -83.
27. El-Solh AA, Pietrantoni C, Bhat A, et al. Microbiology of severe aspiration pneumonia in institutionalized elderly. Am J Respir Crit Care Med, 2003, 167 : 1650-1654.
28. Tokuyasu H, Harada T, Watanabe E, et al. Effectiveness of meropenem for the treatment of aspiration pneumonia in elderly patients. Intern Med, 2009, 48: 129-135.
29. Marik PE, Kaplan D. Aspiration pneumonia and dysphagia in the elderly. Chest, 2003, 124: 328-336.
30. Yoshino A, Ebihara T, Ebihara S, et al. Daily oral care and risk factors for pneumonia among elderly nursing home patients. JAMA,2001, 286: 2235-2236.
31. Yoneyama T, Yoshida M, Matsui T, et al. Oral care and pneumonia.Oral Care Working Group. Lancet, 1999 , 354: 515.
32. Nakajoh K, Nakagawa T, Sekizawa K, et al. Relation between incidence of pneumonia and protective reflexes in post-stroke patients with oral or tube feeding. J Intern Med, 2000, 247: 39-42.
33. Langmore SE, Skarupski KA, Park PS, et al. Predictors of aspiration pneumonia in nursing home residents. Dysphagia, 2002, 17: 298 -307.
34. Drakulovic MB, Torres A, Bauer TT, et al. Supine body position as a risk factor for nasocomial pneumonia in mechanically ventilatedpatients: A randomised trial. Lancet, 1999, 354 , 1851 -1858.
35. Panagiotakis PH, DiSario JA, Hilden K, et al. DPEJ tube placement prevents aspiration pneumonia in high-risk patients. Nutr Clin Pract, 2008 , 23: 172-175.
36. Tokunaga T, Kubo T, Ryan S, et al. Long-term outcome after placement of a percutaneous endoscopic gastrostomy tube. Geriatr Gerontol Int, 2008, 8 : 19 -23.
37. Hennessy S, Bilker WB, Leonard CE, et al. Observed association between antidepressant use and pneumonia risk was confounded by comorbidity measures. J Clin Epidemiol, 2007, 60: 911 -918.
38. Leelamanit V, Limsakul C, Gester A. Synchronized electrical strimuation in treating pharyngeal dysphagia. Laryngoscope, 2002 ,112: 2204-2210.
39. Smith Hammond CA, Goldstein LB. Cough and aspiration of food and liquids due to oral-pharyngeal dysphagia: ACCP evidence-based clinical practice guidelines. Chest, 2006, 129: 154S-168S.
  1. 1. McClave SA, DeMeo MT, DeLegge MH, et al. North American Summit on Aspiration in the Critically ill Patient: consensus statement. J Parenter Enteral Nutr, 2002, 26: S80 -S85.
  2. 2. Shariatzadeh MR, Huang JQ, Marrie TJ. Differences in the features of aspiration pneumonia according to site of acquisition: community or continuing care facility. J Am Geriatr Soc , 2006 , 54: 296 -302.
  3. 3. Schaller BJ, Graf R, Jacobs AH. Pathophysiological changes of the gastrointestinal tract in ischemic stroke. Am J Gasroenterol, 2006 ,101: 1655-1665.
  4. 4. Doggett DL, Tappe KA, Mitchell MD, et al. Prevention of pneumonia in elderly stroke patients by systematic diagnosis and treatment of dysphagia: an evidence-based comprehensive analysis of the literature. Dysphagia, 2001, 16: 279-295.
  5. 5. Teramoto S, Yamamoto H, Yamaguchi Y, et al. A novel diagnostic test for the risk of aspiration pneumonia in the elderly. Chest, 2004 ,125: 801-802.
  6. 6. Pikus L, Levine MS, Yang YX, et al. Videofluoroscopic studies of swallowing dysfunction and the relative risk of pneumonia. Am J Roentgenol, 2003, 180: 1613-1616.
  7. 7. TerréR, Mearin F. Oropharyngeal dysphagia after the acute phase of stroke: predictors of aspiration. Neurogastroenterol Motil, 2006 ,18: 200-205.
  8. 8. Martino R, Foley N, Bhogal S, et al. Dysphagia after stroke incidence, diagnosis, and pulmonary complications. Stroke, 2005 ,36: 2756-2763.
  9. 9. Nakajoh K, Nakagawa T, Sekizawa K, et al. Relation between incidence of pneumonia and protective reflexes in post-stroke patients with oral or tube feeding. J Intern Med, 2000, 247: 39-42.
  10. 10. Katsumata U, Sekizawa K, Ebihara T, et al. Aging effects on cough reflex. Chest, 1995, 107: 290 -291.
  11. 11. Smith Hammond CA, Goldstein LB, Zajac DJ, et al. Assessment of aspiration risk in stroke patients with quantification of voluntary cough. Neurology, 2001 , 56 : 502-506.
  12. 12. Addington WR, Stephens RE, Gilliland KA. Assessing the laryngeal cough reflex and risk of developing pneumonia after stroke: an interhospital comparison. Stroke, 1999, 30: 1203 -1207 .
  13. 13. Tzeng AC, Bach JR. Prevention of pulmonary morbidity for patients with neuromuscular disease. Chest, 2000, 118: 1390 -1396 .
  14. 14. Mansel JK, Norman JR. Respiratory complications and management of spinal cord injuries. Chest, 1990, 97: 1446-1452.
  15. 15. Higenbottam T, Jackson M, Woolman P, et al. The cough response to ultrasonically nebulized distilled water in heart-lung transplantation patients. Am Rev Respir Dis, 1989, 140: 58 -61.
  16. 16. Ebihara S, Saito H, Kanda A, et al. Impaired efficacy of cough in patients with parkinson disease. Chest, 2003, 124 : 1009 -1015 .
  17. 17. Parameswaran K, Anvari M, Efthimiadia A, et al. Lipid-laden macrophages in induced sputumare a marker of oropharyngeal reflux and possible gastric aspiration. Eur Respir J, 2000, 16: 1119 -1122 .
  18. 18. Adams R, Ruffin R, Campbell D. The value of the lipid-laden macrophage index in the assessment of aspiration pneumonia. Aust N Z J Med, 1997, 27 : 550-553.
  19. 19. Farrell S, McMaster C, Gibson D, et al. Pepsin in bronchoalveolar lavage fluid: a specific and sensitive method of diagnosing gastrooesophageal reflux-related pulmonary aspiration. J Pediatr Surg,2006, 41: 289-293.
  20. 20. Metheny NA, Clouse RE, Chang YH, et al. Tracheobronchial aspiration of gastric contents in critically ill tube-fed patients:frequency, outcomes and risk factors. Crit Care Med, 2006 , 34 :1007-1015.
  21. 21. Clayton J, Ryall C. Tracheal pH monitoring and aspiration in acute stroke. Age Ageing, 2006 , 35: 47-53.
  22. 22. GIbson G, Barrett E. The role of salivary function on orophayngeal colonization. Spec Care Dentist, 1992, 12: 153-156 .
  23. 23. Palmer LB, Albulak K, Fields S, et al. Oral clearance and pathogenic oropharyngeal colonization in the elderly. Am J Respir Crit Care Med, 2001, 164: 464 -468.
  24. 24. Sumi Y,Miura H, Michiwaki Y, et al. Colonization of dental plaque by respiratory pathogens in dependent elderly. Arch Gerontol Geriatr, 2007, 44: 119 -124.
  25. 25. Russell SL, Boylan RJ, Kaslick RS, et al. Respiratory pathogen colonization of the dental plaque of institutionalized elders. Spec Care Dentist, 1999, 19: 128-134.
  26. 26. Segal R, Pogoreliuk I, Dan M, et al. Gastric microbiota in elderly patients fed via nasogastric tubes for prolonged periods. J Hosp Infect, 2006, 63: 79 -83.
  27. 27. El-Solh AA, Pietrantoni C, Bhat A, et al. Microbiology of severe aspiration pneumonia in institutionalized elderly. Am J Respir Crit Care Med, 2003, 167 : 1650-1654.
  28. 28. Tokuyasu H, Harada T, Watanabe E, et al. Effectiveness of meropenem for the treatment of aspiration pneumonia in elderly patients. Intern Med, 2009, 48: 129-135.
  29. 29. Marik PE, Kaplan D. Aspiration pneumonia and dysphagia in the elderly. Chest, 2003, 124: 328-336.
  30. 30. Yoshino A, Ebihara T, Ebihara S, et al. Daily oral care and risk factors for pneumonia among elderly nursing home patients. JAMA,2001, 286: 2235-2236.
  31. 31. Yoneyama T, Yoshida M, Matsui T, et al. Oral care and pneumonia.Oral Care Working Group. Lancet, 1999 , 354: 515.
  32. 32. Nakajoh K, Nakagawa T, Sekizawa K, et al. Relation between incidence of pneumonia and protective reflexes in post-stroke patients with oral or tube feeding. J Intern Med, 2000, 247: 39-42.
  33. 33. Langmore SE, Skarupski KA, Park PS, et al. Predictors of aspiration pneumonia in nursing home residents. Dysphagia, 2002, 17: 298 -307.
  34. 34. Drakulovic MB, Torres A, Bauer TT, et al. Supine body position as a risk factor for nasocomial pneumonia in mechanically ventilatedpatients: A randomised trial. Lancet, 1999, 354 , 1851 -1858.
  35. 35. Panagiotakis PH, DiSario JA, Hilden K, et al. DPEJ tube placement prevents aspiration pneumonia in high-risk patients. Nutr Clin Pract, 2008 , 23: 172-175.
  36. 36. Tokunaga T, Kubo T, Ryan S, et al. Long-term outcome after placement of a percutaneous endoscopic gastrostomy tube. Geriatr Gerontol Int, 2008, 8 : 19 -23.
  37. 37. Hennessy S, Bilker WB, Leonard CE, et al. Observed association between antidepressant use and pneumonia risk was confounded by comorbidity measures. J Clin Epidemiol, 2007, 60: 911 -918.
  38. 38. Leelamanit V, Limsakul C, Gester A. Synchronized electrical strimuation in treating pharyngeal dysphagia. Laryngoscope, 2002 ,112: 2204-2210.
  39. 39. Smith Hammond CA, Goldstein LB. Cough and aspiration of food and liquids due to oral-pharyngeal dysphagia: ACCP evidence-based clinical practice guidelines. Chest, 2006, 129: 154S-168S.