老年人肺炎95例临床分析

A Clinical Analysis of 95 Elderly Patients with Pneumonia

老年人肺炎发生高，其严重程度随年龄的增长而加重，是老年病中最常见的致死疾病。我院近３年来共收治６０岁以上老年人肺炎９５例，男６８例，女２７例，年龄６０～９２岁。８３例有慢性基础病，以ＣＯＰＤ、肺心病、糖尿病、高血压和冠心病居多。有吸烟史者６８例，秋末冬春易发病，受凉为常见发病诱因。临床表现主要为发热（４６例）、咳嗽（５６例）、咳痰（５０例）、气促、胸闷、纳差及意识改变。１０例无呼吸道症状。痰培养结果：以Ｇ－杆菌为主，占５０２％，其中以绿脓假单胞菌和肺炎克雷伯杆菌最常见；Ｇ＋球菌占３３５％，以肺炎链球菌和金黄色葡萄菌多见；真菌感染率为１６３％。胸片显示支气管肺炎占６５３％。病变吸收消散慢，平均４周，部分延迟大于２个月。本组４３例出现并发症，死亡９例，死因主要为感染性休克、呼吸衰竭及多脏器功能衰竭。早期诊断及合理选用敏感而强有力的抗菌药物、加强基础病及全身支持治疗。

Among aged population pneumonia has a high incidence and its severe extent increases with increasing of age. Pneumonia is one kind of common disease in elderly. 95 aged patients with pneumonia were admitted into our hospital in recent three years. 68 cases were male and 27 were female. The range of age was 60～92. 83 cases had chronic basic diseases, such as COPD, diabetes, hypertension and coronary heart disease. 68 cases had a history of smoking. The pneumonia often occurred in the autum and spring. Cold was the most frequent factor for the disease. In the clinical manifestations, there were fever, cough, sputum, dyspnea, chest depression, poor appetite and consciousness change in 48 cases, and not any symptoms of respiratory tract in 10 cases. The result of sputum culture showed that gram-negative bacteria accouts for 50.2%, of them, aeruginosa and K. Pneumonia were more commonly found.Gram-positive bacteria for 33.5%, the most frequent appearances were Step. Pneumonia and Staph. aureus. Fungus for 16.3%. 65.3% of cases showed the characteristics of bronchus pneumonia in X-ray films. The X-ray changes disappeared average in 4 weeks but even in two months for parts of cases. 43 cases had complications and 9 dies. Etiology of death included infective shock, respiratory failure and multiple organ failure. Early diagnosis, correct choice of antibiotics, intensive treatment of basic diseases and general support therapy were the key factors to reduce the mortality.