综合性医院老年肺结核临床分析

CLINICAL ANALYSIS ON AGED PATIENTS WITH PULMONARY TUBERCULOSIS IN A GEN ERAL HOSPITAL

目的了解综合性医院老年人肺结核发病的临床特点。方法对64例60岁以上老年肺结核患者的临床资料进行研究,分析其基础疾病、起病和临床特征等。结果本组64例老年肺结核患者有以下几个特点:1.基础疾病多,73.4%者有基础疾病,其中主要为糖尿病、COPD、心血管疾病、肿瘤等;2.起病不典型,午后低热、盗汗等结核中毒症状不典型;3.临床症状不典型,主要表现为咳嗽、咳白痰、咯血、胸闷、发热、乏力、纳差等,发热仅占32.8%;4.患者营养状况差,有贫血者35.9%,存在电解质紊乱者28.1%,患者存在低蛋白血症者32.8%;5.既往有结核病史者多,占56.3%;6.误诊率高,主要为肺炎(41.4%)和肺癌(42.2%)。结论近年来老年结核病疫情严重,临床症状不典型,误诊率高,临床上应及早诊断及治疗。

Chen Jiquan,Luo Wentong.Department of Respiratory Medicine,Changzheng Hospital,Second Milit ary Medical Universicacal feature s of aged patients with pulmonary tub erculosis in a general hospital.Methods The underlying diseases,ways of dis ease starting and the clinical chara cteristic of 64patients more than60years of age with pulmonary tuberc ulosis were analyzed.Results The features of the 64aged patients with pulmonary tuberculosis were as following.(1)The patients were with higher incidence of underlying diseases.In this g roup,73.4%patients had underlying diseases,most of which were diabetes mellitus,COPD,cardiovascular disorders,an d malignant dis-eases.(2)The ways of disease onset were atypic al.There were no tuberculous toxic manifestations such as afternoon low fever,night sweat.(3)The clinical manifestations of these patients had no specific unique features.There were mainly cough,whit e sputum,hemoptysis,chest tightness,fever,tiredness,anorexia.Only32.8%patients had fever.(4)The nutritional con-ditions of these patients were relatively poor.Anemia occurred in 35.9%,electrolyte disturbance in 28.1%a nd hypopro-teinmia in 32.8%;(5)56.3%patients had the history of tuberculosis;(6)The misdiagnosis rate of the pulmonary tuberculosis in the clderly was high,reaching 41.4%.And 42.4%patients in this group were even misdiagnosed as pneumonia a nd lung cancer respectively.Conclusions The incidence of pulmonary tubercul osis in aged people was high with atyp ical clinical manifestations and high misdiagnosis rate.The proper diagnosis and tre atment of these patients should be given as soon as possible.[