老年吸入性肺炎36例临床分析

目的探讨老年吸入性肺炎病因及临床特点。方法对我院收治的36例老年吸入性肺炎患者的临床资料进行分析。结果 36例患者中治愈19例(占52.77%),好转4例(占11.11%),死亡10例(占27.77%),放弃治疗3例(8.33%)。临床表现以发热25例(72.2%)、咳嗽、咳痰24例(66.7%)为著;病原学:革兰阴性杆菌:铜绿假单胞菌14株(38.9%),大肠埃希菌12株(33.3%),肺炎克雷伯菌6株(16.7%);革兰阳性球菌:金黄色葡萄球菌4株(11.1%)、肺炎链球菌3株(8.3%);真菌:白色念珠菌10(27.8%)、曲霉菌9株(25%)。结论老年吸入性肺炎在临床较为常见,以隐性吸入者居多,临床表现不典型,且病死率较高。     

老年患者呼吸机相关性肺炎的病原学以及耐药性分析

目的观察老年患者呼吸机相关性肺炎(VAP)的病原菌分布及药敏特点。方法对40例老年VAP患者的致病菌培养及药敏试验结果进行统计分析。结果本组40例患者共分离出65株致病菌,革兰阴性杆菌49株(75.38%),革兰阳性球菌14株(21.54%),真菌2株(3.08%)。革兰阴性杆菌中感染率居前三位分别为:铜绿假单胞菌18株(27.69%)、鲍曼不动杆菌12株(18.46%)及肺炎克雷伯杆菌9株(13.85%)。革兰阳性球菌以金黄色葡萄球菌最多见为10株(15.38%)。真菌均为白色假丝酵母菌。铜绿假单胞菌、鲍曼不动杆菌及肺炎克雷伯杆菌对亚胺培南、头孢派酮-舒巴坦及哌拉西林-他唑巴担耐药率较低,金黄色葡萄球菌对万古霉素敏感性达100%。结论老年VAP患者致病菌以革兰阴性杆菌多见,且呈多重耐药现象。     

102例老年非发酵革兰阴性杆菌院内获得性肺炎的临床分析

目的探讨老年非发酵革兰阴性杆菌院内获得性肺炎患者的病原学特点及细菌耐药情况,指导治疗和预防。方法回顾性调查2003年1月至2006年12月住院病人中,发生老年非发酵革兰阴性杆菌的院内获得性肺炎（HAP）患者102例进行回顾性分析。结果102例老年非发酵革兰阴性杆菌HAP患者均有基础疾病和诱发因素,检出病原菌有铜绿假单胞菌38株（37.3%）,鲍曼不动杆菌26株（25.5%）,洛菲不动杆菌19株（18.6%）,嗜麦芽窄食单胞菌17株（16.7%）,木糖氧化产碱杆菌xy10亚种2株（2%）。药敏试验显示对多种常用抗菌药物有不同程度耐药,对泰能敏感率较高。结论老年非发酵革兰阴性杆菌HAP患者,多发于有基础疾病,死亡率高,要及早预防,同时进行病原学检查,以指导临床用药。     

老年COPD并社区获得性肺炎常见病原菌及耐药性分析

目的了解老年慢性阻塞性肺疾病（COPD）病人并发社区获得性肺炎常见病原菌及其耐药性的情况，为临床治疗提供参考。方法对我院70例老年COPD并发社区获得性肺炎患者的合格痰标本进行痰培养及药敏试验，对结果进行统计。结果70例患者痰培养阳性者共有40例，共获得致病菌株42株，革兰阴性杆菌占55．0％，其中铜绿假单胞菌最多（22．5％），其次为肺炎克雷伯菌、大肠埃希菌。革兰阳性球菌以肺炎链球菌最多（17．5％），其次为溶血性链球菌及金黄色葡萄球菌。革兰阴性杆菌对三代头孢霉素耐药严重，对头孢他定、头孢哌酮／舒巴坦或碳青霉烯类的抗生素较敏感。而革兰阳性球菌对青霉素几乎全部耐药，未发现对万古霉素耐药。结论老年COPD患者并发社区获得性肺炎的患者常见致病菌以革兰阴性杆菌多见，且耐药严重，临床选择抗生素时应加以注意。     

82例老年吸入性肺炎的临床特征及病原学分析

目的 分析82例老年患者吸入性肺炎的临床特征及病原学特点.方法 收集2010年5月至2011年12月期间入住我院呼吸科、神经科、康复科的82例老年吸入性肺炎的临床资料,统计并分析其临床特点及病原学结果.结果 老年吸入性肺炎患者均有基础疾病及易感因素,临床表现不典型,共检出病原菌127株,革兰阴性杆菌82株(64.6％),革兰阳性球菌32株(25.2％),真菌13株(10.2％).混合感染33例,占40.2％;二重感染14例,占17.1％.结论 提高对老年吸入性肺炎的诊断率,根据其病原学特点合理使用抗菌药物,重视预防老年患者吸入性肺炎的发生具有重要意义.     

呼吸重症监护病房免疫功能低下患者肺炎病原学特点分析

目的 了解呼吸重症监护病房免疫功能低下患者(ICH)肺炎病原体特点及耐药情况,为临床经验性选择抗菌药物提供依据.方法 对2005年1月至2008年4月收住北京朝阳医院呼吸重症监护病房的52例ICH肺炎的痰或肺泡灌洗液培养及药敏试验结果进行回顾性分析.结果 52例ICH肺炎中20例医院获得性肺炎检出42株菌,其中革兰阴性杆菌15株(36.0%),以铜绿假单胞菌、鲍曼不动杆菌和肺炎克雷伯菌为主;革兰阳性球菌13株(31.0%),以肠球菌属和金黄色葡萄球菌为主;真菌11株(26.2%),以曲霉菌和白色念珠菌为主;肺孢子菌3株(7.1%).32例社区获得性肺炎检出57株菌,其中革兰阴性杆菌19株(33.3%),以铜绿假单胞菌、鲍曼不动杆菌和肺炎克雷伯菌为主;革兰阳性球菌16株(28.1%).以肠球菌和金黄色葡萄球菌为主;真菌16株(28.1%),以曲霉菌和白色念珠菌为主;肺孢子菌6株(10.5%).药敏试验显示铜绿假单胞菌对抗生素多重耐药率较高,鲍曼不动杆菌和肺炎克雷伯菌仍对碳青霉烯类较敏感.肠球菌属对万古霉素的耐药率为20.0%,未发现耐万古霉素的葡萄球菌.结论 ICH肺炎中的医院获得性肺炎和社区获得性肺炎病原学特点无差异,感染真菌和革兰阳性球菌比例较高,肺孢子菌肺炎应引起重视,多重耐药菌株高发,耐药率一致.     

老年脑卒中相关性肺炎多重耐药菌感染的危险因素及病原学分析

目的研究老年脑卒中相关性肺炎(SAP)多重耐药菌感染的相关危险因素、病原学分布及耐药性。方法随机抽选该院神经内科149例SAP患者,统计其多重耐药感染情况并进行相关危险因素多因素回归分析,调查其多重耐药菌的病原学特点。结果多因素分析显示意识障碍、是否入住ICU以及晚发性肺炎是SAP多重耐药感染的高危因素。本研究149例SAP患者中分离出多重耐药菌110株,其中革兰阴性杆菌(G-杆菌)以鲍曼不动杆菌(10.9%)、肺炎克雷伯杆菌(15.5%)以及铜绿假单胞菌(27.3%)多重耐药菌属多见;革兰阳性球菌(G+球菌)多重耐药菌属以溶血性葡萄球菌(11.8%)、金黄色葡萄球菌(9.1%)、粪肠球菌(6.4%)较高。结论 SAP多重耐药菌感染的相关高危因素为意识障碍、是否入住ICU以及晚发性肺炎;多重耐药菌对多种抗生素均有不同程度的耐药。应根据其病原学特征,加强抗菌药物的合理使用,积极综合治疗SAP。     

肝硬化并发自发性细菌性腹膜炎患者临床特点、病原学和药敏结果分析*

目的 探讨肝硬化并发自发性细菌性腹膜炎（SBP）患者的临床特点、病原学分布和药敏情况。方法 经细菌培养阳性的60例乙型肝炎肝硬化并发SBP患者,使用德国德灵诊断产品有限公司生产的细菌自动鉴定仪进行细菌鉴定,并采用纸片扩散(K-B)法或MIC法测定细菌对抗菌药物的敏感性。结果 在60例SBP患者中,分离出大肠埃希菌8株（7.1%）、肺炎克雷伯菌7株（11.7%）、鲍曼不动杆菌10株（16.7%）、铜绿假单胞菌6株（10.0%）、阴沟肠杆菌4株（6.7%）、产气肠杆菌3株（5.0%）、葡萄球菌14株（23.3%）和肠球菌8株（13.3%）;对头孢西丁耐药的细菌有大肠埃希菌2株、肺炎克雷伯菌2株、鲍曼不动杆菌1株、铜绿假单胞菌2株、阴沟肠杆菌1株和产气肠杆菌1株;对头孢曲松耐药的细菌有大肠埃希菌1株,肺炎克雷伯菌1株,鲍曼不动杆菌3株,铜绿假单胞菌1株,阴沟肠杆菌2株和产气肠杆菌2株;对亚胺培南耐药的细菌有大肠埃希菌3株,肺炎克雷伯菌3株,鲍曼不动杆菌2株,铜绿假单胞菌1株,产气肠杆菌3株;对克林霉素耐药的细菌有凝固酶阴性葡萄球菌8株,肠球菌2株;对万古霉素耐药的细菌有葡萄球菌1株。结论 肝硬化并发 SBP 患者细菌培养阳性率不高,但在成功分离得到的阳性细菌中以革兰阴性杆菌居多,对亚胺培南的敏感性在降低,而大多数革兰阳性菌仍对万古霉素敏感。     

SCAP和SHAP患者病原体和高危因素研究

目的探讨重症社区获得性肺炎(SCAP)和重症医院获得性肺炎(SHAP)患者分离的病原体及高危因素。方法收集SCAP和SHAP住院患者的临床资料,分离痰、血清或骨髓等标本病原体;对比分析SCAP和SHAP病原体和高危因素。结果 25例SCAP患者病原体阳性12例,明确病原菌16株,其中革兰阳性球菌5株,真菌6株,革兰阴性杆菌3株和肺炎支原体2株。98例SHAP患者病原体阳性95例,分离病原菌131株。20例早发SHAP患者分离病原菌22株,其中革兰阳性球菌14株,革兰阴性杆菌7株,白色念珠菌1株;78例晚发SHAP患者明确病原菌109株,其中革兰阴性杆菌81株,革兰阳性球菌18株,真菌10株。仅28.00%(7例)SCAP具有危险因素;SHAP的常见高危因素有气管切开或插管、机械通气和高龄。结论 SCAP患者病原体分离率显著低于SHAP,SCAP最常见病原体为真菌和革兰阳性球菌,早发SHAP病原体大多为葡萄球菌,晚发SHAP主要为革兰阴性杆菌中的肺炎克雷伯菌、鲍曼/溶血不动杆菌和铜绿假单胞菌,其次为革兰阳性球菌和真菌。SCAP高危因素少,而SHAP具有多种高危因素。     

老年吸入性肺炎89例临床特点分析

目的 探讨老年吸入性肺炎的临床特点,为其治疗提供依据.方法 选择2008年1月～2010年1月收治的89例老年吸入性肺炎患者,回顾性分析其临床表现、辅助检查及治疗、转归情况.结果 临床主要表现为发热和意识改变（占59.6%）;血常规、肺部CT及血气分析无特异性表现,痰培养共检出病原菌126株（革兰阴性杆菌80株、革兰阳性球菌26株、假丝酵母菌20株,混合感染39例）;均予一般对症支持及抗生素降阶梯治疗,治愈48例、好转27例、死亡14例（均伴有3种以上基础疾病）.结论 老年吸入性肺炎的临床表现无特异性,抗生素应用宜根据药敏结果采用降阶梯疗法;合并3种以上基础疾病者病死率高,诊断后应积极治疗.     

老年人脑卒中后昏迷患者单次鼻饲量对吸入性肺炎发生率的影响分析

目的探究分析老年人脑卒中后昏迷患者,单次鼻饲量对吸入性肺炎发生率的影响。方法选取我院收治的老年脑卒中患者64例,按患者意愿分为治疗组与对照组,每组患者均为32例,治疗组患者采取少量鼻饲方法,对照组采取常规鼻饲方法,观察两组脑卒中昏迷患者在单次不同的鼻饲量,发生吸入性肺炎的发生率。结果两组患者经不同的鼻饲量治疗后,治疗组肺炎发生率7例(21.86%)较对照组27例(84.38%)少,对照组患者在各项指标中,血清总蛋白、血清白蛋白、血红蛋白、淋巴细胞等指标较治疗组高,且鼻饲后对照组患者并发症较治疗组患者多,P<0.05,具有统计学意义。结论采用较少量单次鼻饲对老年人脑卒中后伴昏迷患者发生吸入性肺炎例数少,对治疗脑卒中伴昏迷患者有积极作用。     

86例急性脑卒中并吸入性肺炎患者的诊疗体会

目的探讨急性脑卒中患者合并吸入性肺炎的危险因素及处理对策。方法对2005年1月至2008年8月本科收治的86例急性脑卒中合并吸入性肺炎的患者资料进行回顾性分析。结果急性脑卒中后合并吸入性肺炎的发生、发展与患者的年龄、基础免疫力、卒中的部位、病灶大小以及伴发的基础疾病和护理不恰当有关。结论脑卒中急性期易并发吸入性肺炎,对该类患者应及时留置鼻饲管,防止误呛误吸,加强生活护理及康复指导,可有效避免病情进一步恶化。     

The benefit of angiotensin converting enzyme inhibitor for geriatric syndrome in the elderly

Angiotensin converting enzyme (ACE) inhibitor plays an important role not only as an antihypertensive drug but also for prevention of various complications related to geriatric syndrome. Pneumonia in the disabled elderly is mostly due to silent aspiration of oropharyngeal bacterial pathogens to the lower respiratory tract. Aspiration is related to the dysfunction of dopaminergic neurons by cerebrovascular disease, resulting in impairments in both the swallowing and cough reflexes. ACE inhibitor can increase in the sensitivity of the cough reflex particularly in older post-menopausal women, and improvement of the swallowing reflex. In a 2-year follow-up study in stroke patients, patients who did not receive ACE inhibitors had a higher risk of mortality due to pneumonia than in stroke patients who were treated with ACE inhibitor. Moreover, the mortality of pneumonia was significantly lower in older hypertensive patients given ACE inhibitors than in those treated with other antihypertensive drugs. On the other hand, we found a new benefit of ACE inhibitor on the central nervous system. The mortality in Alzheimer's disease patients who received brain-penetrating ACE inhibitor was lower than in those who received other antihypertensive drugs. In a 1-year follow-up study, cognitive decline was lower in patients receiving brain-penetrating ACE inhibitors than in patients receiving a non-brain-penetrating ACE inhibitor or a calcium channel blocker. Brain-penetrating ACE inhibitors may slow cognitive decline in patients with mild to moderate Alzheimer's disease. ACE inhibitor might be effective for the disabled elderly, resulting in the prevention of aspiration pneumonia and Alzheimer's disease for the elderly.     

Tongue-coating as risk indicator for aspiration pneumonia in edentate elderly

Silent aspiration of oral microorganisms is a major cause of aspiration pneumonia. To establish oral hygiene criteria for the prevention of aspiration pneumonia in edentulous elderly persons, we investigated the relationship between presence of tongue-coating and number of oral bacteria in saliva and episodes of pneumonia. A total of 71 edentulous Japanese people aged 65 years or older living in nursing homes were enrolled in the study. A tongue plaque index (TPI) was used to evaluate quantity of tongue-coating, with TPI0 signifying no tongue-coating and TPI1 signifying presence of tongue-coating. Edentate elderly with TPI1 demonstrated significantly higher salivary bacterial counts than those with TPI0 (p < 0.05). The number of elderly patients developing aspiration pneumonia was larger (p < 0.005) in patients with TPI-based poor scores (average TPI > 0.5) than in those with TPI-based good scores. The relative risk of developing pneumonia in the good tongue hygiene group compared with in the poor tongue hygiene group was 0.12, 95% confidence interval (CI): 0.02–0.9. The results demonstrate that tongue-coating is associated with number of viable salivary bacterial cells and development of aspiration pneumonia, suggesting that tongue-coating is a risk indicator of aspiration pneumonia in edentate subjects.     

老年细菌性肺炎纤维支气管镜吸痰样本的菌群分布特征

目的 采用高通量测序技术研究老年细菌性肺炎纤维支气管镜吸痰样本的菌群分布情况.方法 收集上海普陀区利群医院38例65岁及以上临床诊断为细菌性肺炎的未经治疗的患者纤维支气管镜吸痰样本,分别进行传统涂片镜检、痰培养,并采用Illumina Miseq检测细菌16s rDNA,分析菌落组成,比较传统培养与16s rDNA测序...     

血清降钙素原对老年细菌性肺炎临床诊断价值

目的 探讨降钙素原（PCT）对老年细菌性肺炎患者诊断价值的研究.方法 选择230例老年细菌性肺炎患者分成肺炎感染组（A组）、缓解组（B组） 和选择234例健康对照组（N组）作为研究对象,测定血清PCT（procalcitionin,PCT）、血清C-反应蛋白（CRP）和周围血白细胞计数,并对测得结果作比较.结果 老年肺炎患者感染时血清PCT、CRP、周围血白细胞计数明显升高,经过治疗后其患者病情缓解时上述三项参数值明显降低.结论 测定血清PCT比测定血清CRP、周围血白细胞对诊断老年肺炎的价值高,而上述三项联合检测对诊断老年肺炎更具有临床意义.     

Clinical studies on hospital acquired pneumonia in the elderly

We compared hospital acquired pneumonia (HAP) with nursing home acquired pneumonia in the elderly. There were no differences in the underlying diseases, clinical signs and symptoms between HAP and nursing home acquired pneumonia, but activities of daily living were poor in HAP than nursing home acquired pneumonia. By the bacterial studies from Transtracheal aspiration (TTA), S. aureus, K. pneumoniae, P. aeruginosa and anaerobes were more isolated in HAP. On the other hand, S. pneumoniae and H. influenzae were isolated more in the nursing home acquired pneumonia. In the laboratory data, no difference was detected in inflammatory reaction between both groups, but in immunological data, especially complement C3 and tuberculin skin test were markedly reduced in HAP. The prognosis were significantly poor in HAP because the fatal rate was higher in HAP than nursing home acquired pneumonia. With regard to HAP in the elderly, severe underlying disease, poor whole body state, aspiration, bacterial resistance to drugs, superinfection and polymicrobial infection were the factors predisposing difficulty in treatment of pneumonia in the elderly. From the above results, prevention is the most necessary in HAP.     

Pneumonia in Stroke Patients: A Retrospective Study

This is a retrospective study of 378 consecutive stroke patients who were referred between June 1994 and June 1997 for videofluorographic study of oropharyngeal swallow. Patients who had radiation therapy, brain tumor, brain surgery, head and/or spinal cord trauma, oral–pharyngeal disease or surgery, or other neurologic diseases in addition to the stroke were excluded from the study. Patients were assigned to two groups: one with pneumonia and one without pneumonia. One hundred one patients were included in the pneumonia group, and 277 patients were included in the nonpneumonia group. Within the pneumonia group, patients were assigned to an acute pneumonia group (pneumonia within 6 months poststroke) and a chronic pneumonia group (pneumonia more than 6 months poststroke). Variables examined in the study included patients' medical history and the findings from the videofluorographic studies. Pearson chi-square analysis was used to identify those variables that were significantly different between the pneumonia and nonpneumonia patient groups and between the acute and chronic pneumonia groups. Results showed that stroke patients who developed pneumonia had a significantly higher incidence of multiple-location and unspecified lesion strokes, chronic airway disease in their medical history, and aspiration during the videofluorographic studies when compared with patients who did not develop pneumonia. Within the pneumonia group, the acute pneumonia group was found to have a significantly higher incidence of hypertension and diabetes in their medical history and a significantly higher incidence of aspiration and reduced laryngeal elevation during the videofluorographic studies. Between 48% and 55% of all stroke patients in the study aspirated. Patients who suffered multiple strokes, brainstem stroke, or subcortical stroke had the greatest frequency of aspiration.     

Cough in the elderly: a novel strategy for preventing aspiration pneumonia

Management of cough in the elderly with a deteriorated physical and mental status has received little focus. Since an aged population is rapidly increasing in developed countries, the research in this population are warranted. Cough reflex sensitivity in the elderly was shown to be hypersensitive, normosensitive and hyposensitive. The hypersensitive cough reflex is mostly due to gastro-esophageal reflux in nursing home patients. Impaired cough reflex sensitivity is assumed to play a crucial role in the development of pneumonia in the elderly. A marked depression of cough reflex sensitivity is reported in elderly patients with aspiration pneumonia. The impairment of the cough reflex in patients with aspiration pneumonia can involve both cortical facilitatory pathways for cough and medullary reflex pathways. We found the urge-to-cough in patients with aspiration pneumonia was also down-regulated, suggesting the involvement of supramedullary dysfunction in the etiology of aspiration pneumonia in the elderly. In order to prevent aspiration pneumonia in the elderly, restoration of cough reflex sensitivity is essential. We found several methods to restore cough reflex sensitivity in the elderly. They also improved the swallowing reflex, another important airway protective reflex, in the elderly. In the treatment of aspiration pneumonia, one of the most challenging steps is the start of eating for patients who usually fast at the time of hospitalization. By combining the methods to restore the cough reflex sensitivity and swallowing reflex, we developed a protocol to start eating in the elderly patients with aspiration pneumonia. Using the protocol, we reduced the incidence of re-aspiration due to start of eating in patients with aspiration pneumonia to one third of the patients without the protocol.     

细菌性肝脓肿的病原检测及其诊治

目的分析260例细菌性肝脓肿的病原及其诊治。方法回顾性分析260例细菌性肝脓肿临床特点,病原学分布及诊断与治疗方法。结果肝脓肿的主要临床表现为寒战、发热,肝区疼痛。培养所获细菌96株,其中肺炎克雷伯氏菌、大肠埃希氏菌分别占67.7%和11.5%。内科保守治疗89例,B超引导下肝脓肿穿刺抽脓或置管引流142例,肝脓肿切开引流11例,肝叶切除18例。除1例因合并晚期肿瘤死亡,其余病例均获得良好疗效。结论肺炎克雷伯氏菌、大肠埃希氏菌已成为细菌性肝脓肿的优势菌。胆道疾病是细菌性肝脓肿的主要病因。糖尿病是细菌肝脓肿最重要的危险因素。B超引导下肝脓肿穿刺抽脓或置管引流是主要的治疗手段。