不同类型老年吸入性肺炎的临床特点、治疗及转归

Clinical features, therapy and prognosis of different types of aspiration pneumonia in the elderly

目的比较老年吸入性肺炎中社区获得性肺炎（CAP）、医疗相关性肺炎（HCAP）及医院获得性肺炎（HAP）（包括呼吸机相关性吸入性肺炎）的临床特点、治疗及转归。方法收集2005年1月至2010年12月北京第二炮兵总医院呼吸科住院的216例老年吸入性肺炎患者病例，分析其临床特点、治疗及转归。结果三组患者皆以男性居多，且HAP组患者男性比例较其他两组为多（P=0．032），HAP组患者年龄较其他两组为大（P=0．024）；三组患者均有3～4种合并症，合并症的种类和数量并无显著差异；三组间外周血白细胞计数、中性粒细胞比例及X线检查无显著差异；和CAP、HCAP患者相比，HAP患者革兰阴性杆菌感染率尤为高，需联合应用广谱的抗生素药物，特别是针对革兰阴性杆菌药物；HAP组留置胃管、行灌洗吸痰例数要高于CAP组与HCAP组（P〈0．001）；HAP组的治愈率较CAP组与HCAP组低（P〈0．05），死亡率较CAP组高（P=0．004）。结论三种类型老年吸入性肺炎在人口学资料、临床表现上差异不明显，但在治疗及转归等方面有明显差异，应加强对不同类型老年吸入性肺炎的理解和认识，以利于区别化的治疗。

Objective To compare the clinical features, therapy and prognosis of different types aspiration pneumonia in the elderly, which were termed as community-acquired pneumonia （CAP） group, health-careassociated pneumonia （HCAP） group, and hospital-acquired pneumonia （HAP） group （including ventilator-associated aspiration pneumonia）. Methods 216 elderly patients with aspiration pneumonia in the pulmonary department of Beijing 2nd Artillery General Hospital from January 2005 to December 2010 were admitted to our study, and we analysed the difference in clinical features, therapy and prognosis of these patients. Results In the there types of aspiration pneumonia, male patients were obvious much more than female, especially in HAP group （ P =0. 032）. Beyond that,the mean age in HAP group was much older than that in CAP group and HCAP group （ P =0. 024）. All patients had one or more complications and there was no significant difference on numbers and feathers of complications among CAP, HCAP, HAP group. No significant difference was found regarding to the numeration of leukocyte, the rate of neutrophile granulocyte and the X-ray imageology. Compared with CAP group and HCAP group, HAP group had a higher G bacillus infection rate and need more broad-spectrum antibiotics, especially targeting to G- bacillus. HAP patients accepted more nasal feeding and bronchoalvoelar lavage（ P 〈0. 001）, and had a lower recovery rate （ P〈0.05） compared with CAP group and HCAP group, and had a higher mortality rate （ P = 0. 004） compared with CAP group. Conclusions There are no remarkable differences in demographic characteristics and clinical features, but there is significant deviation in therapy and prognosis in the there types of aspiration pneumonia in the elderly. Therefore, special attentions should be paid to deeply understand and recognize these three types of aspiration pneumonia for proper treatment in future.