老年社区获得性肺炎住院患者的临床资料分析

Clinical analysis of community-acquired pneumonia in the elderly

目的总结老年社区获得性肺炎(CAP)患者的临床表现、病原学及预后相关资料。方法回顾性分析2002年1月-2006年1月中山大学附属第三医院收治的成人 CAP 患者的临床资料,比较老年 CAP 患者(年龄>65岁)与中青年 CAP 患者(年龄≤65岁)临床特征的异同。结果成人 CAP 患者302例,年龄(68±21)岁。老年 CAP 患者216例,其中67.1%的患者合并基础疾病,175例(81.0%)患者在 Fine 危险分级Ⅳ～Ⅴ级,住院病死率为12.0%。肺炎链球菌仍是老年 CAP 患者最主要的致病菌。与86例中青年 CAP 患者相比,老年 CAP 患者入院时出现呼吸困难、急性意识障碍、心率增快及呼吸急促的比例明显增多,病原体分布与中青年 CAP 患者存在差异。结论老年CAP 患者发病率高、并发症多、预后差。临床表现、病原学具有其特殊性,应予足够重视。

Objectives To evaluate the clinical features, etiology, and outcome of patients over 65 years old hospitalized for community-acquired pneumonia（CAP）. Methods A retrospective cohort analysis was performed for adult patients hospitalized with CAP in a 1000-bed teaching hospital between Jan 2002 and Jan 2006. Differences between≤65 yrs and 〉 65 yrs groups were calculated using X2 test. Results A total of 302 patients （ 166 males）, with a mean age of （68 ± 21 ） yrs, were enrolled. Of the 216 elderly patients, 67.1% had comorbid conditions, mostly cardiovascular diseases and chronic obstructive lung disease. For the risk stratification, 175 patients were classified as Ⅳ - Ⅴ according to Fine＇s index. The mean hospital stay was 12 days and in-hospital mortality was 12.0%. The most frequent pathogen was Streptococcus pneumoniae in elderly patients. As compared to 86 younger patients （≤ 65yrs）, altered mental status, dyspnea, tachypnea and tachycardia on hospital admission were more frequent in the elderly. The etiological distribution was also different between the two groups. Conclusions CAP in elderly patients is a prevalent disease with high incidence of complications and mortality. More attention should be paid to the specific clinical manifestations of this patient population.