老年支气管哮喘临床诊断探讨

Study on clinical diagnosis of bronchial asthma in senile patients

目的探讨老年哮喘的某些特点，为临床诊断提供线索。方法将临床诊断为慢性喘息性支气管炎（慢喘支）的５１例，按入院时ＰａＣＯ２为６．０ｋＰａ作为界限值进行分组，分别收集临床资料作回顾性分析。结果ＰａＣＯ２低于６．０ｋＰａ组具有起病年龄晚（＞５０岁）、以喘息为主而咳嗽、咯痰不明显、病情重、喘息具昼夜波动的特点，两肺哮鸣音多散在，常不对称，少有湿罗音、对糖皮质激素疗效显著等特点似有别于慢喘支。结论根据老年哮喘的可能特点，提出临床诊断的参考条件认为２４ｈ最大呼气流量（ＰＥＦ）监测是简便、快速诊断的有用方法。

Objective By studying the features of asthma in senile patients,some clues can be provided for asthmatic diagnosis. Methods 51 patients with chronic asthmatic bronchitis were separated into two groups,one group with PaCO 2≤6 0 kPa and the other with PaCO 2>6 0 kPa,and then retrospective analyses were made for the two groups. Results The group with PaCO 2<6 0 kPa had some features,including asthmatic onset ages>50 years,serious wheezing but mild cough and less expectoration,poor condition of illness,significant changes in wheezing day and night,divergent wheeze in two lungs,less wet rale,and satisfactary response to steroid treatment.These features are different from those of chronic asthmatic bronchitis. Conclusions According to the features of senile asthma,some clinical diagnostic principles are put forward and the most useful and rapid method is to monitor PEF in 24 hours.