老年吸入性肺炎125例临床分析

Analysis of clinical features and current therapy for aspiration pneumonia in the elderly

收集2005年6月至2009年10月间呼吸科和神经内科住院治疗的老年吸入性肺炎患者125例做观察。分析发现，老年吸入性肺炎临床表现不典型，以精神萎靡为主（占56％），最多见的基础疾病为神经系统疾病（占64％），并发呼吸衰竭的比例高达46％，且死亡率达21％；病原菌以革兰阴性杆菌为主，占57％；平均住院时间为28d，平均住院费用2．5万元，均明显高于普通肺炎。说明老年吸入性肺炎临床症状不典型、重症患者多、治疗费用大、预后差。

Totally, 125 elderly inpatients with aspiration pneumonia （AP） were enrolled from departments of respiratory medicine and neurology at Zhongnan Hospital, Wuhan during June 2005 to October 2009 for analysis. Results showed that listlessness was manifested in 70 cases （56%）, primary neurological illness in 80 cases （64%）, 57 of them （46%） complicated with respiratory failure and 26 died with case-fatality of 21%. Main pathogen for them was Gram-negative bacillus, accounting for 57% of the total. Two kinds or more of antibiotics had ever been administered in 98 cases （ 78% ） , with an average length of antibiotics use for 28 days, ranging from one day to 128 days. Nasal feeding was instituted for those with choking over their feeding and coughing, and their inspired feeding was aspirated from the trachea or bronchi and lavished with bronchoscopy, with 38 cases by tracheal intubation, 26 by tracheotomy and 42 with artificial ventilation. Their average duration of hospital stay spanned 28 days with an average cost of 25 000 RMB yuan per capita, significantly higher than that for those with common pneumonia. In conclusion, clinical features of these elderly patients with AP were not so typical, most of them manifest severe, with lots of medical cost and bad prognosis.