老年人肺炎的尸检病理与临床结果对照分析  

Comparative analysis of clinical and pathological characteristics of pneumonia in the elderly

作　　者：孙铁英[1] 马正中[2] 李燕明[1] 靳毅明[1] 

机构地区：[1]北京医院呼吸科,100730 [2]北京医院病理科,100730

出　　处：《中华医学杂志》2008年第5期302-306,共5页National Medical Journal of China

摘　　要：目的通过对尸检病理确诊的老年肺炎病例进行临床与病理对照分析，研究老年肺炎的特点，以期为临床提供有益的线索和帮助。方法收集1980至2000年北京医院的尸检资料，选择年龄365岁，尸检病理确诊为肺炎的病例，进行临床与病理对照分析，研究老年肺炎的临床特点。结果尸检证实老年肺炎165例，其中男160例，女5例，年龄66—102岁，平均（84±8）岁。99．4％合并一种或多种基础疾病，合并冠心病113例（68．5％），神经系统疾病82例（49．7％），肿瘤75例（45．5％），慢性阻塞性肺疾病（COPD）50例，肾功能不全47例，糖尿病39例。尸检病理显示，肺炎病理类型以支气管肺炎占绝对优势，大叶性肺炎仅有3例。165例肺炎中明确感染部位者127例，其中88例累及双肺，右肺病变22例，左肺病变17例。38例为多个肺叶累及。79例（47．9％）合并单侧或双侧胸腔积液。吸入性肺炎33例（20％），伴小脓肿形成25例，伴机化性肺炎29例，真菌性肺炎10例，病毒性肺炎4例，伴活动性肺结核病7例。临床诊断肺炎111例，与病理诊断的符合率67．3％。165例老年肺炎的临床表现主要为基础病加重或急性发作或合并症的临床表现，是临床误诊与漏诊的主要原因。临床表现不典型，发热92例（55．7％），不伴有寒战，109例（66．0％）例有呼吸道脓性分泌物，肺部湿哕音81例（49．1％），血白细胞升高78例（47．2％）。胸部X线诊断为肺炎53例（32．0％），伴有胸腔积液28例（16．0％）。结论老年人肺炎临床表现不典型是临床漏诊和误诊的主要原因；慢性基础疾病是老年肺炎最重要的危险因素；老年小叶性肺炎、吸入性肺炎伴有肺脓肿为老年人肺炎常见病理表现；临床上以G^-杆菌、真菌及混合菌感染多见。Objective To study the clinicopathological characteristics of pneumonia in elderly. Methods The clinical and pathological data of 165 patients with autopsy-proven pneumonia, 160 males and 5 females, aged ≥65 （66 - 102）, hospitalized 1980 to 2000 in Beijing Hospital were reviewed. Results 99.4% of the cases had one or more of the 6 diseases concomitantly ： coronary heart disease （CHD） （ n = 113, 68.5% ） , neurological diseases （n =82, 49.7% ） , malignancies （n =75,45.5% ） , COPD （n =50, 30.3%）, renal insufficiency （n =47, 28.5%） , and diabetes mellitus （DM） （n =39, 23. 6%）. Malignancies were found in 75 patients. Bronchial pneumonia predominated the pathological findings, whereas lobar pneumonia was found only in 3 patients. A definite locale was identified in 127 patients, with bilateral involvement in 88 patients, right and left lung involvement in 22 and 17 patients respectively, and 38 patients had the involvement of 〉 2 lobes. Unilateral or bilateral hydrothorax developed in 79 patients. 33 patients were diagnosed as with aspiration pneumonia, in which 25 patients were complicated with small abscess formation, 29 with organizing pneumonia, 10 with fungal pneumonia, 4 with viral pneumonia, and7 with active tuberculosis. 111 cases were diagnosed clinically with an accordance rate with the pathological diagnosis of 67.3%. The manifestations were mainly those of exacerbation or acute onset of the underlying diseases or those of the complicating diseases, which was the main reason of missed diagnosis and misdiagnosis. Only 92 cases （55.7%） were febrile, and rigor was absent. 109 patients （66.0%） produced purulent respiratory expectoration. Moist rale was present at auscultation in 81 cases （49. 1%）. Leucocytosis was seen in 78 cases （47.2%）. Pneumonia was diagnosed by chest X-ray examination in 53 cases （32%） and pleural effusion was diagnosed by chest X ray examination in 28 cases （16%）. Condusion The atypical clinical presentations of pneumonia in

关 键 词：肺炎 吸入性 尸体解剖 老年人 诊断 

分 类 号：R686[医药卫生—骨科学]