老年吸入性肺炎临床探讨

目的　探讨老年吸入性肺炎临床特点及治疗。方法　对 10 2例老年吸入性肺炎患者进行回顾性临床资料分析。结果　老年吸入性肺炎患者伴有多种基础疾病 ,其中以脑血管意外者居多 ,混合感染率较高 ;临床表现不典型 ,原有基础疾病多时 ,死亡率较高。结论　老年吸入性肺炎病情重 ,死亡率高。治疗上应从多环节着手 ,以提高治愈率 ,降低死亡率。     

68例老年吸入性肺炎的临床诊治分析

目的:通过探讨老年吸入性肺炎的临床特点,提高老年吸入性肺炎的诊疗效果。方法:对68例老年吸入性肺炎的临床资料进行回顾性分析。收集包括患者临床表现、基础疾病及合并症、病原微生物培养结果、抗生素选择情况以及患者转归。结果:68例患者中大部分至少伴有1种基础性疾病。68例中治愈46例,好转20例,死亡2例。结论:老年吸入性肺炎临床表现不典型,合并症多,病情凶险,死亡率高。重视痰细菌培养及药敏试验结果,有针对性地合理应用抗生素,可降低细菌耐药率,减少药物不良反应发生,降低死亡率,提高治愈率,大大改善老年吸入性肺炎治疗效果。     

68例老年吸入性肺炎的临床诊治分析

目的：通过探讨老年吸入性肺炎的临床特点，提高老年吸入性肺炎的诊疗效果。方法：对68例老年吸入性肺炎的临床资料进行回顾性分析。收集包括患者临床表现、基础疾病及合并症、病原微生物培养结果、抗生素选择情况以及患者转归。结果：68例患者中大部分至少伴有1种基础性疾病。68例中治愈46例，好转20例，死亡2例。结论：老年吸入性肺炎临床表现不典型，合并症多，病情凶险，死亡率高。重视痰细菌培养及药敏试验结果，有针对性地合理应用抗生素，可降低细菌耐药率，减少药物不良反应发生，降低死亡率，提高治愈率，大大改善老年吸入性肺炎治疗效果。     

血必净注射液治疗脑卒中后老年吸入性肺炎的对照研究

目的:探讨血必净注射液治疗脑卒中后老年吸入性肺炎的治疗效果.方法:将94例脑卒中后老年吸入性肺炎患者随机分为血必净注射液治疗组(47例)和对照组(47例).两组常规给予抗生素、对症及营养支持治疗.血必净注射液组在常规治疗基础上加用血必净注射液50mL,静脉滴注2次/d,连用7 d.观察两组治疗前后患者生命体征,APACHE-Ⅱ评分、外周血白细胞计数、血小板计数,C反应蛋白、血肌酐、血总胆红素、丙氨酸氨基转移酶.结果:疗程结束时,两组体温、呼吸、心率、APACHE-Ⅱ评分、白细胞计数、血肌酐、血总胆红素、丙氨酸氨基转移酶均较治疗前明显下降,差异有统计学意义(P＜0.01),治疗组治疗后上述观察指标下降更明显,与对照组比较差异有统计学意义(P＜0.05);两组血小板计数均较治疗前升高,差异有统计学意义(P＜0.01),治疗组治疗后血小板升高更明显,与时照组比较差异有统计学意义(P＜0.05).结论:血必净注射液能够改善脑卒中后老年吸入性肺炎患者的临床症状和脏器功能,疗效显著,有很好的临床应用价值.     

老年吸入性肺炎33例临床分析

对33例老年吸入性肺炎患者进行回顾性临床资料分析。患者伴有多种基础疾病,其中以脑部疾病居多,临床表现多以发热咳嗽为主,原有基础疾病多时死亡率较高。老年吸入性肺炎病情重,发病率高,死亡率高。治疗上应以综合为主,即在积极有效的抗感染同时,还应重视原发病的治疗,对有误吸的高危患者及早行鼻饲,以提高治愈率,降低死亡率。     

脑卒中后老年吸入性肺炎68例分析

目的：探讨老年卒中患者吸入性肺炎临床特点及治疗。方法：对68例老年吸入性肺炎患者进行回顾性临床资料分析。结果：老年卒中后吸入性肺炎患者伴有多种基础疾病,混合感染率较高,临床表现不典型,原有基础疾病多时,病死率较高。结论：老年卒中后吸入性肺炎病情重,病死率高。治疗上应从多环节着手,以提高治愈率,降低病死率。     

静脉注射联合吸入抗生素治疗呼吸机相关性肺炎97例

目的:研究联合使用吸入抗生素治疗呼吸机相关性肺炎(VAP)的效果。方法:随机对比分析联合使用吸入性抗生素和单独使用静脉抗生素治疗VAP的临床效果。我院ICU的VAP发生率为25.8%,187例VAP患者被分为两组,A组患者采用吸入抗生素联合静脉抗生素,B组单独使用静脉抗生素。结果:A组患者治疗时间明显短于B组,临床治愈率、痰培养转阴率明显高于B组,病死率、复发率无明显差异。结论:联合使用吸入性抗生素能更有效的治疗VAP。     

两种营养方式对老年吸入性肺炎的预后影响

目的比较肠内营养与普通鼻饲对老年吸入性肺炎的预后影响。方法对65例老年吸入性肺炎患者进行回顾性分析,按照不同的营养方式分为2组:肠内营养组和普通鼻饲组,比较2组患者营养状态、治愈率以及抗生素平均使用时间。结果肠内营养组营养状态改善、治愈率以及抗生素平均使用时间均优于普通鼻饲组。结论肠内营养有助于改善老年吸入性肺炎的预后。     

老年吸入性肺炎62例诊治探讨

目的：探讨老年吸入性肺炎的诊断、治疗及预防。方法：对1996年1月至2001年4月在本院住院期间出现吸入性肺炎的62例老年患者的临床特点进行回顾性分析。结果：老年吸入性肺炎多发生于体质差、咳嗽与吞咽功能明显受损的患者，均有发热，69、4％的患者可咯黄痰，部分(38.7％)患者可突然出现气促、紫绀；82．3％患者纤支镜检查发现会厌、声门闭合功能差：小部分患者(9．7％)早期胸片可无明显渗出表现；需机械通气者34例(54．8％)，好转、治愈50例，死亡12例(19．4％)，其中出现急性呼吸窘迫综合征者(12例)死亡5例。结论：老年吸入性肺炎的临床表现无特异性，病死率高，治疗的关键是早期进行支气管肺泡灌洗，缺氧难纠正者及时机械通气治疗；重要的是对有误吸高危因素患者做好积极的预防措施。     

综合护理干预对预防老年吸入性肺炎的影响

目的 探讨护理干预在预防老年吸入性肺炎中的临床应用效果.方法 对2009年1月至2010年12月收住我院老年一科574例卧床老年患者随机分为干预组(306例)和对照组(268例).干预组进行体位护理,进食时采取左侧卧位,半卧位(床头抬高30～45°),吞咽功能训练,加强口腔护理和加强翻身拍背综合护理干预.对照组按老年科常规护理.比较两组患者吸入性肺炎的发生情况.结果 干预组吸入性肺炎发生率较对照组明显下降(x2=27.261,P＜0.01).结论 综合护理干预能有效预防老年吸入性肺炎的发生.     

Nonresolving pneumonia and mimics of pneumonia.

Physicians caring for patients with community-acquired pneumonia are often faced with the dilemma of how to approach a patient with slowly resolving or even nonresolving pneumonia. When the radiograph has failed to resolve by 50% in 2 weeks or completely in 4 weeks, the pneumonia should be considered to be nonresolving or slowly resolving. The causes of a nonresolving pneumonia and an approach to the work-up are presented.     

Prevention of hospital-associated pneumonia and ventilator-associated pneumonia

OBJECTIVE: To synthesize the available clinical data for the prevention of hospital-associated pneumonia (HAP) and ventilator-associated pneumonia (VAP) into a practical guideline for clinicians. DATA SOURCE: A Medline database and references from identified articles were used to perform a literature search relating to the prevention of HAP/VAP. CONCLUSIONS: There is convincing evidence to suggest that specific interventions can be employed to prevent HAP/VAP. The evidence-based interventions focus on the prevention of aerodigestive tract colonization (avoidance of unnecessary antibiotics and stress ulcer prophylaxis, use of sucralfate for stress ulcer prophylaxis, chlorhexidine oral rinse, selective digestive decontamination, short-course parenteral prophylactic antibiotics in high-risk patients) and the prevention of aspiration of contaminated secretions (preferred oral intubation, appropriate intensive care unit staffing, avoidance of tracheal intubation with the use of mask ventilation, application of weaning protocols and optimal use of sedation to shorten the duration of mechanical ventilation, semirecumbent positioning, minimization of gastric distension, subglottic suctioning, avoidance of ventilator circuit changes/manipulation, routine drainage of ventilator circuit condensate). Clinicians caring for patients at risk for HAP/VAP should promote the development and application of local programs encompassing these interventions based on local resource availability, occurrence rates of HAP/VAP, and the prevalence of infection due to antibiotic-resistant bacteria (Pseudomonas aeruginosa, Acinetobacter species, and methicillin-resistant Staphylococcus aureus).     

Influenza-related pneumonia

Influenza-related pneumonia encompasses both primary viral pneumonia and secondary bacterial pneumonia, which may be difficult to differentiate clinically. A high index of suspicion, prompt initiation of antiviral and antibiotic therapy, and appropriate escalation to secondary/critical care are key to improving outcome.     

Overwhelming pneumonia

Overwhelming pneumonia may be caused by a large number of different organisms in both immunocompetent and compromised hosts. In this article, the most common etiologies of overwhelming pneumonia are considered from an epidemiologic and clinical point of view.     

Nosocomial pneumonia

Nosocomial pneumonia remains a challenging problem in critically ill patients in terms of both diagnosis and therapy. The clinical picture is often confusing; confounding factors such as congestive heart failure, ARDS, and interstitial lung disease may obscure the presence of pneumonia. Previous antimicrobial therapy or the presence of large numbers of colonizing organisms contribute to the difficulty of diagnosis. The use of sheathed fiberoptic bronchoscopy with quantitative culture and biopsy is probably the best initial invasive test when routine diagnostic methods fail; open lung biopsy remains the ultimate standard for diagnosis. Empiric therapy is often necessary and should be designed to treat organisms suspected of being the etiologic pathogens either on the basis of preliminary laboratory results (gram and acid-fast stains) or the clinical setting.