自发性纵隔气肿合并成人重度哮喘急性加重
2017/10/23
摘要
目的：成人重度哮喘急性加重合并纵隔气肿的发病率（PNM）仍然是未知的。本研究旨在探讨纵隔气肿与成年重度哮喘患者急性发作的关系，并评估其发生的相关危险因素。
方法：2015年1月1日和2016年12月31日之间连续45例重症哮喘急性发作的住院患者接受如下诊断方案：标准胸片、入院第一个24小时接受动脉血氧饱和度（SaO2）连续监测。患者表现出持续或恶化的血氧饱和度下降进行胸部CT扫描。
结果：在45例患者中5例（11.1%）重症哮喘急性发作的患者被诊断合并纵隔气肿，1例为胸片诊断，4例通过胸部CT诊断。数据分析表明，合并纵隔气肿的患者更年轻[ 21（17-21）vs 49.5（20-73）岁；P＜0.001 ]，并且相对于未合并纵隔气肿者，可能对链格孢属敏感性更高（2 / 5 vs 0 / 40；P = 0.0101）。两组在住院时间上相似[ 8（4-12）vs 7（3-15）天；P = 0.6939 ]。
结论：纵隔气肿是重症哮喘急性加重年轻患者中常见的一种临床疾病，特别是在那些最初的药物治疗反应不佳的患者中。虽然一般都是良性疾病，但因其有发展为严重低氧血症的风险，应对疑似纵隔气肿患者进行密切监测。
Spontaneous Pneumomediastinum Complicating Severe Acute Asthma Exacerbation in Adult Patients.
Vianello A, Caminati M, Chieco-Bianchi F, Marchi MR, Vio S, Arcaro G, Iovino S, Braccioni F, Molena B, Turato C, Peditto P, Battistella L, Gallan F, Senna G.
Abstract
OBJECTIVES: The real incidence of pneumomediastinum (PNM) in adult patients with severe acute asthma exacerbation continues to be unknown. The current study aims to investigate the occurrence of PNM in an adult population of patients presenting a severe asthma attack and to evaluate the risk factors associated to its development.
METHODS: The 45 consecutive subjects who were admitted to our Division between January 1, 2015 and December 31, 2016 for severe acute asthma exacerbation underwent a diagnostic protocol including a standard chest X-ray and continuous monitoring of arterial oxygen saturation (SaO2) during the first 24 hours following admission. The patients showing persistence or deterioration of oxyhemoglobin desaturation were prescribed a chest Computed Tomographic (CT) scan.
RESULTS: Five out of the 45 patients (11.1%) with severe acute asthma exacerbation were diagnosed with PNM, in one case on the basis of an X-ray image and in 4 on the basis of a chest CT scan. Data analysis showed that the PNM patients were younger [21(17-21) vs 49.5 (20-73) yrs; p<0.001] and more likely to show sensitization to Alternaria (2/5 vs 0/40; p = 0.0101) with respect to their non-PNM counterparts. The duration of hospital stay was similar in the two groups [8 (4-12) vs 7 (3-15) days; p = 0.6939].
CONCLUSIONS: PNM is a common clinical entity in young adults with severe acute asthma exacerbation, particularly in those with unsatisfactory response to initial medical therapy. Although generally benign, patients with suspected PNM should be closely monitored because of the risk of developing severe hypoxemia.
目的：成人重度哮喘急性加重合并纵隔气肿的发病率（PNM）仍然是未知的。本研究旨在探讨纵隔气肿与成年重度哮喘患者急性发作的关系，并评估其发生的相关危险因素。
方法：2015年1月1日和2016年12月31日之间连续45例重症哮喘急性发作的住院患者接受如下诊断方案：标准胸片、入院第一个24小时接受动脉血氧饱和度（SaO2）连续监测。患者表现出持续或恶化的血氧饱和度下降进行胸部CT扫描。
结果：在45例患者中5例（11.1%）重症哮喘急性发作的患者被诊断合并纵隔气肿，1例为胸片诊断，4例通过胸部CT诊断。数据分析表明，合并纵隔气肿的患者更年轻[ 21（17-21）vs 49.5（20-73）岁；P＜0.001 ]，并且相对于未合并纵隔气肿者，可能对链格孢属敏感性更高（2 / 5 vs 0 / 40；P = 0.0101）。两组在住院时间上相似[ 8（4-12）vs 7（3-15）天；P = 0.6939 ]。
结论：纵隔气肿是重症哮喘急性加重年轻患者中常见的一种临床疾病，特别是在那些最初的药物治疗反应不佳的患者中。虽然一般都是良性疾病，但因其有发展为严重低氧血症的风险，应对疑似纵隔气肿患者进行密切监测。
（中日友好医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校）
（J Asthma. 2017 Oct 9:0. doi: 10.1080/02770903.2017.1388392）
（J Asthma. 2017 Oct 9:0. doi: 10.1080/02770903.2017.1388392）
Spontaneous Pneumomediastinum Complicating Severe Acute Asthma Exacerbation in Adult Patients.
Vianello A, Caminati M, Chieco-Bianchi F, Marchi MR, Vio S, Arcaro G, Iovino S, Braccioni F, Molena B, Turato C, Peditto P, Battistella L, Gallan F, Senna G.
Abstract
OBJECTIVES: The real incidence of pneumomediastinum (PNM) in adult patients with severe acute asthma exacerbation continues to be unknown. The current study aims to investigate the occurrence of PNM in an adult population of patients presenting a severe asthma attack and to evaluate the risk factors associated to its development.
METHODS: The 45 consecutive subjects who were admitted to our Division between January 1, 2015 and December 31, 2016 for severe acute asthma exacerbation underwent a diagnostic protocol including a standard chest X-ray and continuous monitoring of arterial oxygen saturation (SaO2) during the first 24 hours following admission. The patients showing persistence or deterioration of oxyhemoglobin desaturation were prescribed a chest Computed Tomographic (CT) scan.
RESULTS: Five out of the 45 patients (11.1%) with severe acute asthma exacerbation were diagnosed with PNM, in one case on the basis of an X-ray image and in 4 on the basis of a chest CT scan. Data analysis showed that the PNM patients were younger [21(17-21) vs 49.5 (20-73) yrs; p<0.001] and more likely to show sensitization to Alternaria (2/5 vs 0/40; p = 0.0101) with respect to their non-PNM counterparts. The duration of hospital stay was similar in the two groups [8 (4-12) vs 7 (3-15) days; p = 0.6939].
CONCLUSIONS: PNM is a common clinical entity in young adults with severe acute asthma exacerbation, particularly in those with unsatisfactory response to initial medical therapy. Although generally benign, patients with suspected PNM should be closely monitored because of the risk of developing severe hypoxemia.
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