社区获得性肺炎常见证候及老年患者特征研究

Study on common symptoms and characteristics of community acquired pneumonia in elderly patients

目的总结社区获得性肺炎的常见证候以及老年患者的特征。方法选取2009年10月至2010年10月确诊的社区获得性肺炎老年患者38例，对这些病例的临床资料进行回顾性分析总结。结果所有患者中肺气虚证7例（18．42％），痰湿阻肺证6例（15．79％），痰瘀阻肺证5例（13．16％），脾气虚证4例（10．53％），气阴两虚证4例（10．53％），肺脾气虚证3例（7．89％），肾气虚证3例（7．89％），肺肾气虚证3例（7．89％），肺阴虚证1例（2．63％），肾阴虚证1例（2．63％），肺肾阴虚1例（2．63％）。发热18例（47．37％），胸痛10例（26．32％），咯血2例（5．26％），呼吸困难1例（2．63％），咳嗽28例（73．68％），肺炎双球菌痰培养阳性3例（7．89％）。结论社区获得性肺炎老年患者的发热、胸痛的临床特征并不明显，肺炎双球菌痰培养阳性率低。在临床上当某些老年患者出现原因不明症状的时候，应该仔细辨别，提早进行相关检查警惕社区获得性肺炎的发生。

Objective To summarize the common syndromes and characteristics of community acquired pneu- monia in elderly patients. Method 38 cases were diagnosed from October 2009 to October 2010 in the elderly patients as community-acquired pneumonia, the clinical data were retrospectively analyzed and summarized. Results Among all patients, 7 cases of lung-qi deficiency （18.42%）, pulmonary stagnation of phlegm syndrome in 6 cases （15.79%）, phlegm and blood stasis obstructing lung in 5 cases （13.16%）, spleen qi deficiency syndrome in 4 cases （10.53%）, 4 cases of Qi and yin deficiency syndrome （10.53%）, lung spleen qi deficiency syndrome in 3 cases （7.89%）, kidney-qi deficiency syndrome in 3 cases （7.89%）, 3 cases of lung qi deficiency syndrome （7.89%）, 1 case of deficiency of kidney yin deficiency syndrome （2.63%）,1 cases （2.63%）, lung and kidney in 1 case （2.63%）. The onset of fever in 18 cases, the incidence was 47.37%; the appearance of chest pain in 10 cases, the incidence was 26.52%; onset of haemoptysis in 2 cases, the incidence was 5.26%; 1 case appeared dyspnea, cough and incidence rate was 2.63%; in 28 cases, the incidence was 73.68%; pneumococcus sputum culture was positive in 3 cases, the positive rate was 7.89%. Conclusion The fever, chest pain is not apparent as clinical features in community acquired pneumonia in elderly patients, the pneumococcus sputum culture positive rate decreased. When there is some unexplained symptoms in older patients without obvious causes, we should carefully distinguish the relevant examination, to early detect the occurrence of community acquired pneumonia.