老年社区获得性肺炎的临床特征分析  

Analysis on Clinical Characteristics of Community-acquired Pneumonia in Elderly Patients

作　　者：王炜[1] 李鸿雁[1] 孙海清[1] 胡永霞[1] 姚俊秀[1] 

机构地区：[1]成都军区总医院干部病房,成都610083

出　　处：《华西医学》2012年第6期863-865,共3页West China Medical Journal

摘　　要：目的探讨老年社区获得性肺炎的临床特征、病原学特点及抗生素的合理选择。方法选择2010年1月1日-12月31日呼吸内科和干部病房住院治疗并确诊为社区获得性肺炎,年龄≥60岁的126例患者,从病原学、临床表现、辅助检查结果及治疗转归方面入手,回顾性分析老年社区获得性肺炎的临床特征。结果 77.7%(98/126)的老年社区获得性肺炎患者合并有其他基础疾病,其中84.7%(83/98)合并慢性阻塞性肺病,81.6%(80/98)合并高血压,39.2%(40/98)合并冠心病,25.5%(25/98)合并有糖尿病。126例患者中,68.3%(86/126)有气促等呼吸道症状,75.6%(95/126)有食欲减退等消化道症状,61.1%(77/126)有反应迟钝等精神状态的改变;72.2%(91/126)的患者肺部体征明显,而27.8%(35/126)的患者无明显肺部体征;88.9%(112/126)的老年患者胸部CT提示有斑点状、小片状阴影。有89例患者进行了痰培养,其中58例出现阳性结果,46例对头孢菌素敏感、36例对喹诺酮类药物敏感、39例对氨基糖甙类敏感及青霉素敏感。给予抗感染、支持对症治疗后,56.3%(71/126)的患者治愈、33.3%(42/126)的患者病情好转、10.3%(13/126)的患者死亡,死亡原因均为呼吸衰竭。结论老年社区获得性肺炎患者临床特征复杂,应重视其社区获得性肺炎的早期诊断,并进行及时有效的治疗。Objective To explore the clinical features, pathogenic characteristics and the reasonable selection of antibiotics for elderly patients with community-acquired pneumonia. Methods The clinical manifestations, etiology, laboratory findings and the therapeutic outcomes of 126 elderly patients above 60 years old with community-acquired pneumonia treated in our hospital between January 1 st and December 31 st 2010 were retrospectively analyzed. Results A total of 77.7% （98/126） of the elderly community-acquired pneumonia patients were accompanied with underlying diseases, including 84.7% （83/98） of chronic obstructive pulmonary disease, 81.6% （80/98） of hypertension, 39.2% （40/98） of coronary heart disease, and 25.5% （25/98） of diabetes. Among the 126 elderly patients, 68.3% （86/126） had respiratory symptoms, 75.6% （95/126） had gastrointestinal symptoms, and 61.1% （77/126） had mental abnormalities; 2.2% （91/126） had obvious signs of pulmonary infection, while 27.8% didn＇t have the signs. Chest CT examination revealed that 88.9% （112/126） of the patients had spots or small patchy shadows in their lungs. Of the 89 patients who took sputum culture examination, positive results were found in 58; and drug sensitivity test suggested that 46 were sensitive to cephalosporin, 36 were sensitive to quinolones, and 39 were sensitive to aminoglycoside. After giving anti-infection and symptomatic treatment of support, 56.3% （71/126） of the patients were clinically cured, 33.3% （42/126） were improved, and 10.3% （13/126） died. Conclusions The clinical characteristics of community-acquired pneumonia in elderly patients are complex. Attention should be paid to the early diagnosis of community-acquired pneumonia in elderly people, and timely and effective treatment should be carried out.

关 键 词：老年 社区获得性肺炎 病原学 临床特征 抗生素 预后 

分 类 号：R563.1[医药卫生—呼吸系统]