흡입화상에 의한 반응성 기도과민 증후군
Reactive Airways Dysfunction Syndromes Induced by Inhalation Injury
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목 적 : 흡입 화상이란 불완전 연소된 부산물의 흡입에 의해 이차적으로 발생한 기도의 화학적 화상으로 폐에 여러 가지 합병증을 남길 수 있으며, 이로 인한 사망률이 높다. 흡입 화상으로 인한 폐 합병증 중 반응성 기도과민 증후군(reactive airways dysfunction syndrome, RADS)은 기존의 호흡기 질환이 없던 사람이 급성으로 호흡기 자극 물질에 노출된 후에 지속적인 기도과민 반응이 나타나는 질환으로 천식 혹은 천식과 비슷한 증상을 보인다. 이에 흡입화상을 겪은 환아들에서 반응성 기도과민 증후군이 얼마나 발생하는 지, 임상적인 특성은 어떠한 지를 조사하고자 하였다.방 법 : 화재로 인한 흡입 화상으로 병원에 입원한 과거력이 있는 9명의 환아들을 대상으로, 화상 8개월 후에 임상증상, 폐기능 검사(기초 폐기능 및 폐확산능 검사), 유발검사(메타콜린 기관지유발 검사, 운동유발검사), 방사선 검사(흉부 방사선 검사, 흉부 고해상도 단층 촬영)를 시행하였다. 아토피와 감염 질환의 유무를 확인하기위해 피부단자시험, 혈청검사 등을 시행하였다. 결 과 : 평균 나이 11세의 남아들로 화재시 9명 중 5명이 피부의 화상을 입었고 5명이 의식을 잃었다. 모두 운동을 할 때 호흡곤란, 기침 등의 증상이 있었다. 입원당시 모두 산소를 투여하였으며 평균 3.7일의 산소투여가 있었다. 전신적, 혹은 국소적 스테로이드 치료를 받은 환아는 4명이었다. 단순 흉부 방사선 검사는 모두 특이 소견이 없었으나 흉부 고해상도 단층 촬영에서 3명이 mosaic pattern을 보였다. 기초 폐기능 검사에서 1명에서 FEV1(%predicted)가 의미 있게 감소를 하였고, 2명에서 FEF25-75%가 감소되어 있었다. 메타콜린 기관지유발검사에서 4명이 양성(PC20<8 mg/mL) 소견을 보였다. 운동 유발검사상 3명에서 FEV1과 FEF25-75%가 의미 있게 감소하였고, 1명에서 FEF25-75%만 의미 있게 감소하였다.결 론:흡입 화상 8개월 후에도 상당수에서 기도과민반응 등 반응성 기도과민 증후군에 합당한 소견이 있음을 확인할 수 있었으며 이러한 환자들은 향후 지속적인 추적관찰과 관리가 필요하다고 생각한다.
Abstract
Purpose : Reactive airways dysfunction syndrome(RADS) is characterized by the appearance of asthma-like symptoms and an increase in nonspecific bronchial hyperresponsiveness in previously healthy individuals after a single large exposure to irritating gas, fume, or vapor, usually as a result of an accident. The purpose of this study is to evaluate the incidence of RADS and clinical characteristics after inhalation injury in children. Methods : We analyzed nine male children with inhalation injuries from an elementary school fire accident. Clinical manifestations, PFTs including provocation test by methacholine and exercise, radiologic evaluations, skin test and serologic test for evidence of allergy were evaluated at 8 months after the inhalation injury. Results : No documented preexisting respiratory illness was identified, nor did subjects relate past respiratory problems. All subjects suffered from the persistence of respiratory symptoms(cough on exertion, dyspnea on exertion or voice change in five subjects). All subjects showed normal chest X-rays, but a mosaic pattern was documented in the HRCT of three subjects. Basal FEV1(%predicted) was decreased in one subject and FEF25-75% was decreased significantly in two subjects. Methacholine challenge test was positive in four subject and Exercise provocation tests showed significant decreases of FEV1 and FEF25-75% in three subjects. In four subjects, atopy was documented and but in all others, no evidence of atopy was identified. Conclusion : This study showed that RADS could develop after inhalation of irritants, and might persist. Inhalation injury patients should be closely monitored on respiratory symptoms and PFT.
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