직업성 폐질환 Occupational Lung Diseases

목차

1. 직업성 폐질환 (Occupational Lung Diseases)

2. 물리화학적 손상

본문내용

ted over as many as 30 fraction)
3) Acute phase : 1-2 month after radiation exposure
Subacute phase : 2-9 months later
Chronic phase : 9 month 후
4) 방사선 소견
치료 완료 후 1-3 개월째 잘 나타난다.
straight edge 의 ground glass appearance
5) 치료
supportive care : cough suppression, antipyretics, oxygen
corticosteroid(prednisone 1 mg/kg)
antibiotics therapy
6. Aspiration pneumonitis
pulmonary injury caused by acidic stomach content
* aspiration pneumonia : infectious process by oropharyngeal flora contaminating the tracheobronchial tree
1) main factors determining the extent of illness
(1) pH of the aspirate : pH < 2.5 → severe pneumonitis
(2) presence of food particle
(3) volume of the aspirate : > 0.4 ml/kg
(4) distribution of aspirate
2) Intratracheal instillation후에 12-18초에 pleura에 도달하고, 30분 이내에 bronchial secretion에 의해 중화된다.
gastric acid aspiration 1-5시간 후에 tachycardia, rales, rhonchi, wheezing, cyanosis, cough, hypotension이 나타나고 36시간이내에 50%에서 fever발생
3) 치료
(1) airway 유지
(2) oxygen supplementation
(3) bronchodilator
(4) prophylactic antibiotics : not recommended
(5) systemic corticosteroid : not used routinely
(6) positive pressure ventilation
(7) H2 receptor blocker or antacid를 수술 2시간 전에 주어서 pH를 증가시킨다.
4) 예후
mortality : 28-62%
(1) Factor associated with high mortality
① age>50
② early development of shock or apnea
③ severe or prolonged hypoxemia
④ very low pH of gastric content at the time of aspiration
⑤ development of secondary bacterial pneumonia
7. Hydrocarbon Pneumonitis
1) direct toxic effect of volatile hydrocarbon on the respiratory epithelium and vasculature
2) 흡인 : 5세 이하 아이들의 사고로 인한 흡인
suicide
siphoning of gasoline
alcoholics seeking an ethanol substitute
3) lower viscosity or larger volume, the worse the lesion
4) 증상
dyspnea, tachypnea, high fever
bloody sputum, lethargy, disturbance of consciousness
leukocytosis
hypoxemia(shunt and V/Q mismatching)
CXR : infiltrate within 20-30min after aspiration
multiple, fluffy, ill-defined infiltrate on the dependent area
5) 치료
(1) emesis : contraindicated
(2) gastric lavage by nasogastric tube
: cuffed endotracheal tube를 넣은 후에 시행
(3) supplemental oxygen
(4) mechanical ventilation & PEEP
(5) antibiotics
(6) corticosteroid (prednisone 1 m/kg) : during the acute phase
8. Lipoid Pneumonia
Exogenous lipoid pneumonia : aspiration of vegetable, animal or mineral oils
Sputum of macrophages with clusters of vacuoles 5 to 50 μm in diameter that stain deep orange with Sudan IV
9. Near Drowning
1) Wet drowning : 대부분의 경우에 해당하며 initial laryngospasm후에 바로 relaxation되면서 많은 양의 fluid를 흡인하는 경우
2) Dry drowning : glottic spasm이 지속되어 흡인 없이 질식하는 경우로 10-20% 차지
3) Hypoxemia 원인
(1) occlusion of airways with water and particulate debris
(2) changes in surfactant activity
(3) direct injury to alveolar septa
(4) bronchospasm
4) Treatment
(1) Maintain airway
(2) Oxygen supplementation
(3) 24시간은 입원시켜두고 관찰 (ARDS 발생 가능)
(4) CPAP & PEEP
(5) nebulized -agonist & intravenous theophylline : bronchospasm 치료
(6) head and neck injury 확인 요함.

키워드

폐,   lung,   흡연,   직업,   방사선,   석면폐증