Pneumonia knowledge - radiation pneumonitis

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Radiation pneumonitis is caused by lung cancer, breast cancer, esophageal cancer, malignant lymphoma or other malignant tumors of mediastinu

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Radiation pneumonitis is caused by lung cancer, breast cancer, esophageal cancer, malignant lymphoma or other malignant tumors of mediastinum and chest wall. The severity of lung injury was closely related to the dose of radiation, the area of irradiation and the speed of irradiation. The pathological changes showed acute exudative inflammatory reaction and chronic pulmonary fibrosis. The clinical manifestations of mild changes, can be asymptomatic, severe because of extensive pulmonary fibrosis caused by respiratory dysfunction and even death. Glucocorticoid has a certain effect on acute inflammation.

Clinical manifestation

1 the light had no symptoms, most in radiation therapy 2-3 months after onset of symptoms. The symptoms appeared in the six months after radiotherapy. Common symptoms: irritating dry cough; shortness of breath, after aggravating; chest pain; with or without fever, fever to more; with dysphagia caused by radiation esophagitis; severe cases can appear serious dyspnea, cyanosis.

2 chest radiation can be seen in the local skin atrophy harden.

3 most of the lungs without positive signs. When there is extensive pulmonary fibrosis, alveolar respiration generally weakened, and audible crepitus (Velcro rales). As a secondary bacterial infection, can smell and dry and wet rales. A pleural friction sound. Accompanied by pulmonary heart disease, there may be signs of right heart failure.

Diagnosis basis

1 history of radiation therapy.

2 dry cough, dyspnea and pulmonary rales have characteristic velcro.

3 chest X-ray examination revealed lung inflammation or fibrosis. More than one month after stopping radiation therapy. In acute phase, there was a large or dense shadow in the irradiated lung field, which was similar to that of bronchial pneumonia or pulmonary edema. In the chronic phase, the pulmonary fibrosis is characterized by reticular, strip or mass like contraction, and is mainly distributed on both sides of the hilar or mediastinal and other radiation fields. Due to the ipsilateral lung fiber contraction, displacement of trachea, heart, ipsilateral diaphragmatic elevation, produce compensatory emphysema of normal lung tissue. Pulmonary artery hypertension occurs when the pulmonary artery is prominent or the right heart hypertrophy. Pleural effusion syndrome.

Supplementary Examination

Pulmonary function change

Both lung and fibrosis were associated with restrictive ventilatory dysfunction, decreased lung compliance, decreased ventilation / blood flow ratio, and reduced dispersion, leading to hypoxia. Sometimes chest X-ray has not been found abnormal, and pulmonary function tests have been shown to change.

X-ray manifestation

The majority of patients with radiation after cessation of radiotherapy in January. In the acute phase, the temperature of the lung field appeared in the presence of the temperature of the patchy fuzzy shadow, which can be seen in the reticular shadow, bronchial pneumonia or pulmonary edema. The range of lesions was consistent with the surface of the thorax. Chronic pulmonary fibrosis occurs as a funicular or mass like contraction or localized atelectasis. There are a large number of mediastinal pleural and pericardial adhesions to the ipsilateral mediastinal shift, ipsilateral diaphragmatic elevation and collapsed chest.

Treatment principle

1 adrenal cortex hormones control inflammation. 2 anticoagulant therapy is effective in preventing small vessel embolization. 3 high concentration oxygen therapy to improve hypoxemia. 4 appropriate use of antibiotics to prevent secondary infection.

Medication principle

1 patients can choose oral prednisone or dexamethasone. 2 critically ill patients with intravenous dexamethasone. 3 combined with pulmonary infection, with antibiotics.

How to home care?

(1) positive psychological counseling, so that patients can maintain a good state of mind, establish the confidence to overcome the disease. The family needs to accompany the patient, to take care of life.

(2) to the attention of respiratory frequency and depth of observation of patients, such as patients with cyanosis, dyspnea should be semi supine, given oxygen inhalation, conditional intravenous prednisone or dexamethasone, to relieve symptoms.

(3) to observe the daily temperature changes, mild fever can be given to 30% alcohol or warm water bath. Hegu massage Yongquan, Quchi, etc., or available hormone and antibiotics intravenously. Chinese medicine cooling available bupleurum root injection, Chuanhuning Injection, Qingkailing injection etc..

(4) pay attention to changes in the patient cough and symptoms of phlegm is not easy to cough up, can pat on the back, up to help expectoration. Oral mixture of liquorice, bisolvon. If the patient cough can not sleep, oral codeine 0.3 grams.

(5) to keep the room clean, fresh air, indoor temperature is generally in the range of 18 ~ 20 DEG C is appropriate, humidity to 60% ~ 65% is preferred.

(6) pay attention to changing clothes, bed sheets, bedding. To keep the mouth clean, increase resistance to disease, prevent cross infection. Smokers must quit smoking.

 

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