不同类型老年肺炎临床及病原学特点的比较分析

Comparative analysis of clinical and etiology characteristics in different types of senile pneumonia

目的:探讨老年卫生保健相关性肺炎(health-care-associated pneumonia,HCAP)、社区获得性肺炎(community-acquired pneumonia,CAP)及医院获得性肺炎(hospital-acquired pneumonia,HAP)临床和病原学特点的异同。方法:对本院2011年3月至2014年10月我院呼吸科、老年科、ICU病房共332例老年肺炎患者(其中CAP152例、HCAP102例、HAP78例)的临床资料和痰培养资料进行回顾性分析,计量资料采用方差检验,计数资料采用卡方检验。结果:3组患者在合并基础疾病方面差异无明显统计学意义(P>0.05);3组病例在肺部啰音、咳嗽及呼吸困难方面均有差异(P<0.05):CAP组啰音发生率为83.3%(125/152),呼吸困难发生率为38.2%(58/152),明显低于HCAP组和HAP组,检验P值分别为0.006和0.009;HCAP组咳嗽[90.2%(92/102)]高于其他2组(P=0.002)。病原学方面3组微生物检出率存在差异(P<0.05),CAP组肺炎链球菌[27.0%(41/152)]和流感嗜血杆菌[19.1%(22/152)]高于其他2组,而铜绿假单胞菌[7.9%(12/152)]和真菌[2.0%(3/152)]低于其他2组(P<0.01);而HAP组中鲍曼不动杆菌检出率较高,为29.5%(23/78),高于其他2组,P为0.000。HCAP组死亡率[23.5%(24/102)]接近HAP组[25.6%(20/78)](P=0.744),且明显高于CAP组[5.3%(8/152)](P<0.01)。结论:老年肺炎临床表现差异大,致病菌复杂多样,应合理使用抗生素及综合治疗;HCAP在临床特点、病原学以及治疗预后等方面均有自己的特点,真菌发病率高,病死率高。

Objective ：To investigate the similarities and differences of etiology and clinical characteristics in the elderly health care associated pneumonia （HCAP） and community-acquired pneumonia（CAP） and hospital-acquired pneumonia （HAP）. Methods：The clinical data and sputum culture data of 152 cases of CAP and 102 cases of HCAP and 78 cases of HAP in our hospital were retro- spectively analyzed. Data were analyzed using SPSS 17.0 statistical software and using analysis of variance and chi square test. Results： There was no obvious statistical significance difference in the general condition of three groups（P〉0.05）. There were significantly dif- ferences in the lung rale, cough and difficulty breathing among three groups （P〈0.05）;while the rale rate was 83.3% （125/152） and difficulty breathing rate was 38.2%（58/152） in CAP group,significantly lower than those of other groups（P=0.006,P=0.009）. There were significant differences among three groups in etiology aspects （P〈0.05）. In CAP,the common strains of streptococcus pneumoniae [27.0% （41/152）] and haemophilus influenzae[19.1% （22/152）] were higher than those of other groups, and the pseudomonas aerugi- nosa[7.9% （12/152）] and fungi[2.0% （3/152）] were lower（P〈0.01）. The detection rate of acinetobacter baumannii was 29.5% （23/ 78）,higher than those of other groups（P=0.000）. The mortality rates were 23.5% （24/102） in HCAP group,25.6%（20/78） in HAP group and 5.3% （8/152） in CAP group （P〈0.01）. Conclusion：Clinical manifestation of senile pneumonia appears diversified and pathogenic bacteria is complicated. The clinical characteristics and prognosis of etiology and treatment in HCAP group have its owncharacteristics. High incidence of fungi and high mortality rate should be reasonable use for antibiotics and comprehensive therapy.