老年与非老年患者社区获得性肺炎的临床对照研究

目的 探讨老年与非老年患者社区获得性肺炎(CAP)的临床特点,为临床治疗提供依据.方法 收集2007-2009年于北京安贞医院呼吸科和呼吸重症监护病房住院的CAP患者的临床资料,进行总结分析.结果 老年CAP患者临床症状不典型,常表现为非呼吸道症状,多伴有基础疾病表现,易合并低蛋白血症、贫血、电解质紊乱,低钠、低钾血症;老年CAP组平均住院时间比非老年CAP组住院时间长,但差异无统计学意义;老年CAP组平均住院费用比非老年CAP组住院费用多,差异有统计学意义(P＜0.01);老年CAP组患者均合并基础疾病,以心血管疾病和COPD多见;根据肺炎严重程度评分(PSI),35例老年CAP组患者中,评分为Ⅲ级的10例占29.0％、Ⅳ级20例占57.0％、V级5例占14.0％;非老年CAP组患者25例,均为PSI评分Ⅰ～Ⅱ级;老年CAP组34例好转,1例死亡,住RICU 7例占20.0％,需要机械通气4例占11.0％;非老年CAP组患者均好转.结论 老年CAP患者临床症状不典型,极易漏诊、误诊,值得高度重视;老年CAP患者年龄大、基础疾病及合并症多,预后差,应及早进行综合性治疗,提高治愈率、降低病死率;通过PSI可进行危险分层以全面评估CAP患者病情,筛选高危患者,确定适宜的治疗方案,改善患者预后,合理应用医疗资源.

Community-acquired pneumonia in elderly patients and the non-elderly patients:a clinical control study

OBJECTIVE To explore the clinical features of community-acquired pneumonia(CAP) in the elderly patients and the non-elderly patients so as to provide bases for the clinical treatment.METHODS Retrospective analysis of the clinical data of the patients with CAP who enrolled in respiratory department and RICU Beijing Anzhen Hospital from 2007 to 2009 was performed.RESULTS The elderly patients with CAP had atypical clinical symptoms,which usually manifesting as non-respiratory symptoms accompanied by underlying diseases,easily complicating by hypoproteinemia,anemia,electrolyte imbalance,hyponatremia and hypokalemia;the mean hospital stay of the elderly patients with CAP was longer than that of the non-elderly patients with CAP,the difference was not statistically significant;the mean cost of the hospitalization of the elderly patients with CAP was significantly more than that of the non-elderly patients with CAP,the difference was statistically significant(P<0.01);all the elderly patients with CAP were with underlying diseases among which the cardiovascular diseases and chronic obstruction pulmonary diease were most common;according to the score of PSI,10 cases(29.0%)of the 35 elderly patients with CAP were Ⅲ class,20 cases(57.0%)Ⅳ class,5 cases(14.0%)Ⅴ class;all the 25 non-elderly patients with CAP were with the PSI score varying at Ⅰ-Ⅱ class;34 elderly patients with CAP improved,1 case died,there were 7 cases(20.0%) who were hospitalized in RICU,4 cases(11.0%)who underwent mechanical ventilation;all the non-elderly patients with CAP improved.CONCLUSION The elderly patients with CAP had atypical clinical symptoms,easily being missed diagnosis or misdiagnosis,which is worthy of attention;more attention should be paid to the elderly patients with CAP because of the great age,complex underlying diseases and complications and the poor prognosis,it is necessary to conduct the comprehensive treatment in a timely manner so as to improve the cure rate and reduce the mortality;by means of PSI,we canhave a comprehensive assessment of risk stratification in patients with CAP,screen high-risk patients,determine theappropriate treatment programs to improve the prognosis of patients with CAP as well as apply the medical resources reasonably.