The large spectrum of pulmonary complications following illicit drug use: Features and mechanisms
The large spectrum of pulmonary complications following illicit drug use: Features and mechanisms
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DOI：
10.1016/j.cbi.2013.10.011
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发表时间：
2013-12-05
影响因子：
5.1
通讯作者：
Chevillard, Lucie
中科院分区：
文献类型：
--
作者：
Megarbane, Bruno;Chevillard, Lucie
全身性和吸入性接触各种非法滥用药物可能会对肺部造成损害。吸入性肺炎可能是最常见的与意识障碍有关的肺部并发症。某些肺部后果可能与特定药物有关。长期吸食大麻可能导致呼吸道症状，提示阻塞性肺病。非心源性肺水肿被归因于海洛因，尽管有争议的机制，包括试图对封闭的声门吸气，缺氧损伤肺泡完整性，神经源性血管活性反应的压力，阿片类药物诱导的过敏样反应。纳洛酮相关的突然戒断导致大量交感神经反应伴心脏顿抑被错误地牵连。在可卡因使用者中，在吸入游离碱可卡因后48小时内报告了被称为“爆裂肺”的急性呼吸综合征，伴有发热、咯血、呼吸困难和胸部X线肺浸润，其特征为肺水肿、间质性肺炎、弥漫性肺泡出血和嗜酸性粒细胞浸润。挥发的可卡因的高温和杂质的存在，以及可卡因引起的局部血管收缩被认为可以解释肺泡损伤。一些其他药物相关的肺损伤是由药物自我给药途径引起的。在静脉注射毒品者中，胸部影像学上多结节样的肉芽肿性肺炎是由于药物污染物如尼古丁引起的。右心内膜炎引起的脓毒症栓塞是肺源性脓毒症的另一种诊断。吸入后，气胸和肺气肿归因于与剧烈咳嗽或反复Valsalva动作相关的胸内压升高，以试图吸收最大可能的药物量。总之，非法药物对肺部造成的后果是多种多样的，既有危及生命的急性病症，也有长期的功能性呼吸道后遗症。更好地了解他们的频谱和相关的损伤机制，应有助于改善患者的管理。(C)2013爱思唯尔爱尔兰有限公司版权所有。
Damage to lungs may occur from systemic as well as inhalational exposure to various illegal drugs of abuse. Aspiration pneumonia probably represents the most common pulmonary complication in relation to consciousness impairment. Some pulmonary consequences may be specifically related to one given drug. Prolonged smoking of marijuana may result in respiratory symptoms suggestive of obstructive lung disease. Non-cardiogenic pulmonary edema has been attributed to heroin, despite debated mechanisms including attempted inspiration against a closed glottis, hypoxic damage to alveolar integrity, neurogenic vasoactive response to stress, and opiate-induced anaphylactoid reaction. Naloxone-related precipitated withdrawal resulting in massive sympathetic response with heart stunning has been mistakenly implicated. In crack users, acute respiratory syndromes called "crack-lung" with fever, hemoptysis, dyspnea, and pulmonary infiltration on chest X-rays have been reported up-to 48 h after free-base cocaine inhalation, with features of pulmonary edema, interstitial pneumonia, diffuse alveolar hemorrhage, and eosinophil infiltration. The high-temperature of volatilized cocaine and the presence of impurities, as well as cocaine-induced local vasoconstriction have been suggested to explain alveolar damage. Some other drug-related pulmonary insults result from the route of drug self-administration. In intravenous drug users, granulomatous pneumonia with multinodular patterns on thoracic imaging is due to drug contaminants like talcum. Septic embolism from right-sided endocarditis represents an alternative diagnosis in case of sepsis from pulmonary origin. Following inhalation, pneumothorax, and pneumomediastinum have been attributed to increased intrathoracic pressure in relation to vigorous coughing or repeated Valsalva maneuvers, in an attempt to absorb the maximal possible drug amount. In conclusion, pulmonary consequences of illicit drugs are various, resulting in both acute life-threatening conditions and long-term functional respiratory sequelae. A better understanding of their spectrum and the implicated mechanisms of injury should help to improve patient management. (C) 2013 Elsevier Ireland Ltd. All rights reserved.