老年吸入性肺炎与非吸入性肺炎患者的临床特点及预后比较

Clinical features and prognosis of aspiration pneumonia compared with non-aspiration pneumonia in the elderly patients

目的探讨老年吸入性肺炎和非吸入性肺炎患者的临床特点、治疗效果及预后差异,指导临床治疗。方法收集2013年10月至2015年8月于武汉大学中南医院收治的老年肺炎病例185例,其中男102例,女83例,年龄65~96岁。其中吸入性肺炎94例,非吸入性肺炎91例,回顾分析两组的临床特点、治疗效果及预后转归。结果吸入性肺炎组平均年龄(80.8±6.7)岁,明显大于非吸入性肺炎组;吸入性肺炎组合并脑血管疾病及神经系统疾病更多见,病情严重程度更重,平均住院时间(25.4±8.2)d,较非吸入性肺炎组长9.3 d。两组患者临床表现、外周血白细胞、中性粒细胞,肺部CT影像学表现差异不明显(P>0.05)。吸入性肺炎组患者细菌培养显示病原菌以混合感染比率更高(54.3%vs.30.8%,P<0.05),其中鲍曼不动杆菌感染率明显高于非吸入性肺炎组(P=0.004);初始经验治疗吸入性肺炎组抗生素以联合使用更常见,后续调整抗生素比率、复发率和死亡率均较非吸入性肺炎组高,临床疗效和预后吸入性肺炎组较非吸入性肺炎组差。结论两组患者临床表现,实验室及影像学表现差异不明显,但两组平均年龄、基础健康状况、病原学特点和治疗预后等方面有明显差异。应加强老年吸入性肺炎的早期诊断,积极防治,降低死亡率,提高老年人的生活质量和健康水平。

Objective To investigate the differences of clinical features and prognosis between aspiration pneumonia(AP) and non-aspiration pneumonia(non-AP) in the elderly patients. Methods 185 elderly patients with pneumonia in our hospital from October 2013 to August 2015 were admitted, among which 102 cases were male, female 83 cases, 65-96 years old, the AP and non-AP cases were 94 and 91 respectively. The differences in clinical features and prognosis of the two groups were analyzed. Results The mean age of AP group was(80.8±6.7) years old, and was significantly higher than that of non-AP group. AP patients had more comorbidities with cerebrovascular and neural system diseases, more severe disease and required longer hospital stays. No significant difference was found regarding to the clinical manifestation, the numeration of leukocyte, the neutrophile granulocyte and the lung CT imageology. The mixed infection rate was higher in AP patients(54.3% vs. 30.8%, P<0.05), and of those main infection pathogenic bacteria, the acinetobacter baumannii infection rate was also higher than the non-AP patients(P=0.004). Initial treatment for the combined use of antibiotics and the subsequent adjustment of antibiotics were more common in AP group, the rate of recurrence and mortality was also higher, however, the recovery rate was lower and its prognosis was poorer. Conclusions There were no remarkable deviations in the clinical manifestation, laboratory and imaging examination, but there were significant differences in the mean age, basic health status, etiology characteristics, treatment and prognosis in the two groups. Therefore, more attentions should be paid to strengthen the early diagnosis of AP, active prevention and treatment, reduce mortality, and improve the life quality and health level in elderly.