社区获得性肺炎老年住院患者的临床分析

Retrospective analysis of clinical data of elderly patients hospitalized with community-acquired pneumonia

目的 调查社区获得性肺炎 (CAP)老年住院患者的临床资料 ,分析其病原特点、严重程度及预后 ,以供临床参考。 方法 回顾分析CAP住院患者的临床资料 ,对照分析研究其年龄、基础病、1年内因肺炎住院史、病原学特点和CAP严重程度及死亡率。 结果 315例CAP中 ,男 2 15例 ,女 10 0例 ,年龄 18～ 10 2岁 ,平均 (6 4± 2 4 )岁。根据年龄分为老年组 2 5 2例 (80 % ) ;非老年组 6 3例 (2 0 % )。 180例 (5 7 2 % )未能明确病原。基础病的特点为 ,非老年组CAP患者基础病少 ;老年组CAP患者均患 1种以上的基础病。CAP患者严重程度分层和转归 :按肺炎预后评分系统 (PORT)进行分层 ,Ⅰ级 31例 (9 9% ) ,无死亡 ;Ⅱ级 32例 (10 1% ) ,1例死亡 (3 1% ) ;Ⅲ级 198例 (6 2 8% ) ,5例死亡 (2 5 % ) ;Ⅳ级 4 0例 (12 7% ) ,1例死亡 (2 5 % ) ;Ⅴ级 14例 (4 5 % ) ,9例死亡 (6 4 5 % )。Ⅱ级以上患者在 1年内因CAP住院占 5 0 %以上。 结论 慢性基础疾病是老年CAP的重要的危险因素。 1年内因CAP住院在CAP的发病和增加其危险度方面起着重要的作用。半数以上的CAP患者感染的病原不明 ,表明CAP有效的初始经验治疗十分重要。

Objective To investigate community acquired pneumonia(CAP)in the elderly hospitalized in Beijing Hospital during recent 10 years, and to facilitate and promote the CAP management. Methods Retrospective study was done on the clinical data of 315 patients with CAP hospitalization, with keystone on the characterization of age, concomitant disease, history of hospitalization due to CAP, pneumonia severity, and pathogens. Results In 315 cases, 215 males, 100 females. The age ranged from 18～102 years, with average age (64±24) years and median 68 years. Three hundreds and fifteen patients were classified to the elderly group (≥ 60 years) of 252 casess (80%) and non elderly group (≤59 years)of 63 cases(20%). The complex and severe concomitant diseases,such as hypertension, coronary disease, COPD, cerebrovascular disease etc. occurred in the group of elderly group. Fifty seven percent cases of CAP were not defined in the pathogens. Using Prognostic Scoring Systems of Pneumonia Patient Outcomes Research Team (PORT) to define the pneumonia severity, there were 31 cases of a risk class Ⅰwithout dead case, 32 cases of classⅡ with 1 patient dead, 198 cases of class Ⅲ with death rate 2.5%, 40 cases of class Ⅳwith death rate 4.5%, and the higher death rate 64.5% ( 9 cases died) was in 14 cases of class Ⅴ. >50% cases of risk class Ⅱhad the history of hospitalization due to pneumonia. Conclusions The important risk factors of CAP are the history of hospitalization due to pneumonia, except the aged and concomitant disease. In more than half of CAP cases of the pathogens can not be separated. It is importants to facilitate and promote the experience initial therapy in CAP management.