Liu J F, Yan Z F, Dai J S, Wen X H, Wang N Y
Department of Otorhinolaryngology-Head and Neck Surgery,Beijing Chaoyang Hospital,Capital Medical University,Beijing,100020,China.
Department of Otorhinolaryngology,Dongzhimen Hospital,Beijing University of Chinese Medicine.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2016 Sep 5;30(17):1363-1368. doi: 10.13201/j.issn.1001-1781.2016.17.006.
To investigate the causes of barium aspiration,death rate and the cause of death in the upper gastrointestinal examinations,and to help the doctor selecting a reasonable method in upper gastrointestinal tract examination.Two cases in our hospital was reported,and totally 25 patients in 22 articles were obtained in pubmed or google shchoolar form 1989 to 2014.Purpose of radiologic studies of the upper digestive tract,distribution of the aspirate,clinical presentation and prognosis after aspiration of the sulfate barium in literature were collected.①Aspiration of barium sulfate mainly happened in elderly patients and infant.The age of died group were older than survive group,however,there were no significant difference statistically(=0.909, =0.355).②The directly mortality rate associated with barium aspiration was up to 38.1% in adult,and ten patients of them(47.6%) recovered.All the infants were recovered completely form the respiratory distress cause by the aspiration of barium sulfate.③Aspiration may more likelyoccur in certain conditions involving dysphagia and esophageall obstruction by tumor or foreign body.Further,the gastro-esophageal reflux,recent esophageal surgery,eructation and vomiting may also increase the risk of aspiration of the aspiration of barium sulfate.④About 84.0% patients were with initial dyspnea,hypotension,respiratory distress or respiratory failure.A minority of patients without significant reactions,only suffered fever and cough(16.0%).⑤The deposition of barium sulphate were commonly affected both lungs(80.0%).Barium sulfates distributed in unilateral lung only were found in five patients 20.0%.Aspiration may easier occur in certain conditions involving dysphagia and esophageall obstruction by tumor or foreign body.Further,the gastro-esophageal reflux,recent esophageal surgery,eructation and vomiting may also increase the risk of aspiration of the aspiration of barium sulfate.Most of the patients after aspiration of barium were presented with initial dyspnea,hypotension,respiratory distress or respiratory failure.When considerable amounts of barium sulfate are aspirated into the lung leading to arterial hypoxemia and dyspnea,it is mandatory that aggressive treatment with steroids,antibiotics,respiratory physiotherapy,oxygen,and bronchoalveolar lavage is initiated without delay.
为探讨上消化道检查中钡剂误吸的原因、死亡率及死亡原因，以帮助医生在上消化道检查中选择合理的检查方法。报告我院2例病例，并通过PubMed或谷歌学术检索1989年至2014年共22篇文献中的25例患者。收集上消化道放射学检查目的、误吸物分布、硫酸钡误吸后的临床表现及预后。①硫酸钡误吸主要发生在老年患者和婴儿。死亡组年龄大于存活组，但差异无统计学意义（t = 0.909，P = 0.355）。②成人钡剂误吸相关的直接死亡率高达38.1%，其中10例患者（47.6%）康复。所有婴儿均从硫酸钡误吸引起的呼吸窘迫中完全康复。③误吸更易发生在某些存在吞咽困难以及肿瘤或异物导致食管梗阻的情况下。此外，胃食管反流、近期食管手术、嗳气和呕吐也可能增加硫酸钡误吸的风险。④约84.0%的患者最初出现呼吸困难、低血压、呼吸窘迫或呼吸衰竭。少数患者无明显反应，仅出现发热和咳嗽（16.0%）。⑤硫酸钡沉积通常累及双肺（80.0%）。仅5例患者（20.0%）硫酸钡分布于单侧肺。误吸更易发生在某些存在吞咽困难以及肿瘤或异物导致食管梗阻的情况下。此外，胃食管反流、近期食管手术、嗳气和呕吐也可能增加硫酸钡误吸的风险。大多数钡剂误吸患者最初表现为呼吸困难、低血压、呼吸窘迫或呼吸衰竭。当大量硫酸钡吸入肺内导致动脉血氧不足和呼吸困难时，必须立即积极使用类固醇、抗生素、呼吸物理治疗、吸氧和支气管肺泡灌洗进行治疗。
