老年社区获得性肺炎的临床分析  

Clinical study of community-acquired pneumonia in the elderly

作　　者：范建[1] 黄成亮[1] 范贤明[1] 

机构地区：[1]泸州医学院附属医院呼吸内二科,四川省泸州市646000

出　　处：《实用老年医学》2015年第4期311-314,共4页Practical Geriatrics

摘　　要：目的分析老年社区获得性肺炎(CAP)的临床特点。方法收集2012年2月至2013年11月本院呼吸内科确诊CAP且年龄≥18岁患者495例,分为老年组(≥65岁)与非老年组(<65岁),比较2组肺炎患者临床数据的差异。结果老年患者临床表现胸痛(9.1%)、咯血(4.1%)少见,双下肢水肿(21.6%)、意识障碍(9.4%)等多见;实验室检查中性粒细胞计数升高(65.9%)、肝功能损害(24.1%)、肾功能损害(22.2%)、电解质紊乱(32.8%)、低白蛋白血症(42.5%)、呼吸衰竭(37.8%)常见;合并症以心力衰竭(25.0%)、心血管疾病(34.4%)、脑血管疾病(16.3%)、慢性阻塞性肺疾病(COPD)(54.4%)多见;有创机械通气(9.4%)、经验性抗生素治疗失败(31.9%)、抗真菌药物治疗(13.1%)及死亡(7.5%)比例高,以上数据与非老年组比较差异均有统计学意义(P<0.05)。结论老年CAP患者合并症与并发症多,临床表现不典型,经验性治疗效果差,死亡风险高,临床医师需要特别注意老年肺炎的临床特点,避免误判患者病情,延误诊治。Objective To analyze the clinical characteristics of community-acquired pneumonia（ CAP） in the elderly. Methods The clinical data of 495 cases with CAP aged 18 years old and over were collected from February 2012 to November 2013 in the respiratory department. They were divided into two groups： elderly group（ ≥65 years old） and nonelderly group（ 65 years old）. The characteristics of symptoms,signs,laboratory examination results,underlying diseases,complications,treatment measures and outcomes of the patients were compared between the two groups. Results Compared with non-elderly group,the incidence rate of chest pain（ 9. 1%）,hemoptysis（ 4. 1%）,the edema of lower limbs（ 21. 6%）,disturbance of consciousness（ 9. 4%）,neutrophil count（ 65. 9%）,liver function damage（ 24. 1%）,renal impairment（ 22. 2%）,electrolyte disorder（ 32. 8%）,low serum albumin levels（ 42. 5%）,respiratory failure（ 37. 8%）,heart failure（ 25. 0%）,cardiovascular diseases（ 34. 4%）,cerebrovascular disease（ 16. 3%）,COPD（ 54. 4%）,invasive mechanical ventilation（ 9. 4%）,empirical antibiotic treatment failure（ 31. 9%）,antifungal drugs（ 13. 1%） and death（ 7. 5%） in elderly group showed significant differences（ P〈0. 05）. Conclusions To avoid misjudgment and to improve diagnosis and treatment in elderly patients with CAP,more attention should be paid to the elderly patients with CAP because of atypical clinical manifestations,complex underlying diseases and complications,poor effect of empiric therapy and high risk of mortality.

关 键 词：老年人 社区获得性肺炎 临床特征 

分 类 号：R563.1[医药卫生—呼吸系统]