Bauer M L, Figueroa-Colon R, Georgeson K, Young D W
Department of Pediatrics, University of Alabama, Birmingham.
South Med J. 1993 Jul;86(7):789-95. doi: 10.1097/00007611-199307000-00015.
According to established diagnostic and therapeutic guidelines for chronic pulmonary aspiration, clinical suspicion is raised by coughing and choking with feeding, coughing during sleep, recurrent pneumonia, failure to thrive, and radiologic signs of chronic lung injury. The upper gastrointestinal series accurately defines anatomy and function, can differentiate between direct and reflux aspiration, and identifies conditions that predispose to aspiration. Gastroesophageal scintigraphy lacks anatomic detail but increases observation time, may differentiate between direct and reflux aspiration, and identifies delayed gastric emptying and gastroesophageal reflux. The lipid-laden macrophage index improves identification of aspiration, but cannot differentiate between direct and reflux aspiration. The esophageal pH probe identifies gastroesophageal reflux. Treatment options include medical therapy (thickened feedings, prone positioning, and metoclopramide) and surgical intervention (gastrostomy, fundoplication, and definitive correction of predisposing conditions). Therapy is determined by severity of illness and results of diagnostic evaluation.
根据已确立的慢性肺误吸诊断和治疗指南，喂养时咳嗽和呛噎、睡眠中咳嗽、反复肺炎、生长发育不良以及慢性肺损伤的影像学表现会引发临床怀疑。上消化道造影能准确界定解剖结构和功能，可区分直接误吸和反流误吸，并识别易导致误吸的情况。胃食管闪烁显像缺乏解剖细节，但延长了观察时间，可区分直接误吸和反流误吸，并识别胃排空延迟和胃食管反流。载脂巨噬细胞指数有助于提高对误吸的识别，但无法区分直接误吸和反流误吸。食管pH值监测可识别胃食管反流。治疗选择包括药物治疗（增稠喂养、俯卧位和甲氧氯普胺）和手术干预（胃造口术、胃底折叠术以及对易患因素的确定性纠正）。治疗方案由疾病严重程度和诊断评估结果决定。
