肺部细菌感染评分用于大面积脑梗死并发吸入性肺炎患者预后评估的研究北大核心CSCD

目的探讨肺部细菌感染评分(CPIS)对大面积脑梗死(LHI)并发吸入性肺炎患者预后的评估价值。方法 2018年1月-2020年12月本院收治的LHI合并吸入性肺炎患者116例,均根据自身情况选择合适营养方式,住院31~97 d,依据住院后生存状况分为死亡组和生存组。收集患者的性别、年龄、既往病史、饮酒、吸烟、入院收缩压及美国国立卫生研究院卒中量表(NIHSS)评分,入院24 h血常规、肾功能指标、血糖、血脂等资料,根据简化的CPIS标准对其中的体温、气管分泌物、氧和指数、胸部X线片等进行评分,采用Logistic回归分析法分析影响LHI合并吸入性肺炎患者死亡的危险因素;绘制受试者工作特性曲线(ROC),分析CPIS对LHI合并吸入性肺炎患者死亡的诊断价值。结果 116例患者LHI合并吸入性肺炎患者住院期间生存91例(78.45%),死亡25例(21.55%)。与生存组相比,死亡组入院NIHSS评分、肌酐、胱抑素C、CPIS均升高(均P<0.05)。Logistic回归分析显示,胱抑素C、CPIS是影响LHI合并吸入性肺炎患者死亡的危险因素(均P<0.05)。ROC曲线显示,CPIS预测LHI合并吸入性肺炎患者死亡的ROC曲线下面积为0.857,截断值为6.13,敏感性为82.89%,特异性为80.21%。结论 LHI并发吸入性肺炎死亡患者CPIS升高,是影响患者死亡的独立危险因素,且对患者的预后评估具有一定参考价值。     

肺部细菌感染评分用于大面积脑梗死并发吸入性肺炎患者预后评估的研究

目的探讨肺部细菌感染评分(CPIS)对大面积脑梗死(LHI)并发吸入性肺炎患者预后的评估价值。方法 2018年1月-2020年12月本院收治的LHI合并吸入性肺炎患者116例,均根据自身情况选择合适营养方式,住院31～97 d,依据住院后生存状况分为死亡组和生存组。收集患者的性别、年龄、既往病史、饮酒、吸烟、入院收缩压及美国国立卫生研究院卒中量表(NIHSS)评分,入院24 h血常规、肾功能指标、血糖、血脂等资料,根据简化的CPIS标准对其中的体温、气管分泌物、氧和指数、胸部X线片等进行评分,采用Logistic回归分析法分析影响LHI合并吸入性肺炎患者死亡的危险因素;绘制受试者工作特性曲线(ROC),分析CPIS对LHI合并吸入性肺炎患者死亡的诊断价值。结果 116例患者LHI合并吸入性肺炎患者住院期间生存91例(78.45%),死亡25例(21.55%)。与生存组相比,死亡组入院NIHSS评分、肌酐、胱抑素C、CPIS均升高(均P0.05)。Logistic回归分析显示,胱抑素C、CPIS是影响LHI合并吸入性肺炎患者死亡的危险因素(均P0.05)。ROC曲线显示,CPIS预测LHI合并吸入性肺炎患者死亡的ROC曲线下面积为0.857,截断值为6.13,敏感性为82.89%,特异性为80.21%。结论 LHI并发吸入性肺炎死亡患者CPIS升高,是影响患者死亡的独立危险因素,且对患者的预后评估具有一定参考价值。     

老年吸入性肺炎的临床特点和防治对策

目的 探讨老年吸入性肺炎的临床特点以及防治对策.方法 收集2004年3月～ 2009年5月老年吸入性肺炎住院患者56例,分析临床和病原学的特点.结果 老年吸入性肺炎患者56例,死亡15例,好转41例.结论防治老年吸入性肺炎应根据病原学进行有效抗菌治疗.     

脑卒中患者吸入性肺炎研究进展

吸入性肺炎是脑卒中的常见并发症,也是脑卒中患者病情加重及死亡的原因之一。据统计脑卒中患者并发肺部感染率为5.6%～14.0%,15%～25%脑卒中患者死于肺部感染,肺部感染以吸入性肺炎为主[1-3]。因此,积极预防吸入性肺炎对提高脑卒中患者的生存质量及降低死亡率有重要意义。本文就脑卒中     

两种管饲法在预防老年脑梗死合并吸入性肺炎的疗效观察

目的 观察鼻胃管和鼻肠管两种管饲法在预防老年脑梗死患者合并吸入性肺炎的效果差异.方法 选取87例老年脑梗死患者,随机分为鼻胃管组、鼻肠管组、对照组,比较三组患者吸入性肺炎的发生率.结果 鼻肠管组吸入性肺炎发生率低于鼻胃管组,鼻胃管组吸入性肺炎的发生率低于对照组.结论 鼻肠管管饲法在保障脑梗死患者营养摄入的同时,还有效降...     

Elixhauser合并症指数可评估重症吸入性肺炎患者的预后

目的:探讨Elixhauser合并症指数(ECI)与重症吸入性肺炎患者院内死亡之间的关系,并评价其对吸入性肺炎患者院内死亡的预测价值。方法:运用T-SQL语言从美国重症医学数据库(MIMIC-Ⅲ)中提取患者人口学特征、合并症等临床资料,运用单因素分析、多因素logistic回归分析和分层分析评价ECI与重症吸入性肺炎患者院内死亡之间的关系,通过受试者工作特性(ROC)曲线评估ECI预测院内死亡的临床价值。结果:共纳入402例患者,其中存活患者330例,死亡患者72例。单因素分析结果提示年龄、机械通气、ECI和CRUB-65评分与患者的院内死亡相关(P均0. 05);多因素logistic回归分析提示ECI≥21分是院内死亡的独立危险因素[OR值(95%CI):1. 98(1. 14,3. 45),P=0. 0154]; ECI预测院内死亡的ROC曲线下面积为0. 6169 (95%CI:0. 5424,0. 6913),与CRUB-65评分相比无显著差异。结论:ECI≥21分是重症吸入性肺炎患者院内死亡的独立危险因素,可用于初步评估患者的预后。     

老年卒中相关性肺炎患者病原学分析

目的探讨老年卒中相关性肺炎的病原学特征。方法收集2005年10月～2010年6月呼吸科住院的230例老年患者卒中后细菌性吸入性肺炎病例,统计并分析其病原学特点。结果卒中后细菌性吸入性肺炎临床表现不典型,诊断较为困难,共检出病原菌316株。革兰阴性杆菌（G-杆菌）206株（65.2%）,革兰阳性球菌（G＋球菌）62株（19.6%）,真菌48株（15.2%）,混合感染127例（40.2%）,其中革兰阴性杆菌以铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌属多见,且耐药率较高。结论老年卒中患者并发吸入性肺炎在临床较为多见,预后较差,根据其病原学特点合理使用抗菌药物,加强综合治疗,积极防治老年卒中患者吸入性肺炎的发生。     

脑卒中患者并发吸入性肺炎的原因分析及护理方法探析

目的分析脑卒中患者并发吸入性肺炎的原因分析及护理方法。方法随机抽取在我院治疗的脑卒中并发吸入性肺炎患者291例,回顾患者临床资料,分析患者并发吸入性肺炎原因,并给予患者不同护理方法,对比患者护理效果。结果观察组患者心理功能、躯体功能、精神功能、社会功能较对照组显著改善,护理后SAS评分、SDS评分较对照组显著降低,病死率2.74%(4/146)低于对照组患者病死率12.41%(18/145),住院时间较对照组明显缩短,差异有统计学意义,P0.05。结论重视分析脑卒中患者并发吸入性肺炎原因,积极呼吸道护理,加强患者吞咽功能训练,从而提高患者生活质量。     

老年脑卒中合并吸入性肺炎临床特征观察

目的观察老年脑卒中患者吸入性肺炎的临床特征。方法选择50例老年脑卒中合并吸入性肺炎患者作为观察组,观察其临床表现、实验室及辅助检查、痰培养结果、危险因素(按1∶1比例选择无吸入性肺炎的老年脑卒中患者作为对照组,对两组患者有关因素进行统计比较)、治疗及预后。结果具有典型呼吸系统表现26例,不典型24例;肺部影像学出现叶或段实变阴影、肺不张10例;下肺42例。Ⅰ型呼吸衰竭22例、Ⅱ型呼吸衰竭8例、低氧血症12例、正常8例。痰培养结果致病菌生长37例,以革兰氏阴性杆菌为主,混合性细菌生长10例。观察组年龄大、存在吸烟史、合并糖尿病、意识障碍、制酸剂应用、鼻饲时间长、白蛋白水平低于对照组(P0.05),为引起吸入性肺炎的危险因素。死亡4例。结论老年脑卒中患者吸入性肺炎临床表现不典型,痰培养分离菌复杂,影响因素多种,增加致残及死亡率,应重视脑卒中合并吸入性肺炎患者的预防工作,早期诊断和及时有效的治疗。     

老年吸入性肺炎患者42例临床治疗观察

目的：探究42例老年吸入性肺炎患者的最佳临床治疗效果。方法选取我院2012年4月～2013年9月间收治的老年吸入性肺炎患者42例,分为两组。对照组单纯应用药物治疗,观察组在药物治疗的同时配合采用振动排痰的方式治疗,对比两组临床疗效。结果经过治疗,观察组痊愈患者15例,死亡1例,总有效率为94．73％。对照组痊愈患者12例,死亡3例,总有效率为82．60％。观察组不良反应发生率（10．52％）与对照组（26．08％）相比明显较低,细菌清除率高,两组临床治疗前后对比,差异有统计学意义（ P＜0．05）。结论针对老年吸入性肺炎患者采用振动排痰联合药物的方法治疗,疗效确切,安全有效,值得临床中广泛应用。     

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。     

Association between sarcopenia and pneumonia in older people

Pneumonia is a major cause of death in older people, and the number of such deaths is increasing. Present guidelines for pneumonia management are based on a pathogen‐oriented strategy that relies on the optimal application of antibiotics. Older pneumonia inpatients show the high incidence of aspiration pneumonia. The main cause of aspiration pneumonia is an impairment in the swallowing and cough reflexes. These facts suggest a limitation of present management strategies and a requirement for new strategies for aspiration pneumonia. Sarcopenia is the loss of muscle strength and mass, and declining physical function with aging. Recently, a decrease in the mass or strength of the swallowing muscles was suggested to be associated with reduced swallowing function. Accordingly, dysphagia caused by sarcopenia of the systemic and swallowing‐related muscles was named sarcopenic dysphagia. Presently, few studies have shown associations between aspiration pneumonia and sarcopenic dysphagia. As for the cough reflex, strong cough prevents aspiration pneumonia, and its strength is regulated by respiratory muscles. A few studies have reported a relationship between muscles and pneumonia in older people. Sarcopenia is a risk factor for pneumonia in older people, and aspiration pneumonia inpatients with low muscle mass show high mortality rates. Aspiration pneumonia induced muscle atrophy in respiratory, swallowing, and skeletal muscles in an animal model and humans. Associations between respiratory muscle strength and pneumonia are currently under investigation. Evaluation and management of sarcopenia could potentially become a new strategy to prevent and treat pneumonia in older patients, and research has only recently been launched. Geriatr Gerontol Int 2020; 20: 7–13 .     

呼吸机相关性肺炎危险因素临床分析

目的 探讨呼吸机相关性肺炎危险因素.方法 选择实施呼吸机治疗130患者作为研究对象,观察呼吸机相关性肺炎与年龄、性别、APACHEⅡ评分、有关药物(镇静剂、制酸剂)、误吸和反流、呼吸机应用时间的关系.结果 130例患者发生呼吸机性相关性肺炎40例(30.77%),呼吸机性相关性肺炎患者APACHEⅡ评分(30.74±3.13)、应用镇静剂制酸剂32.50%、误吸和反流27.50%、呼吸机应用时间(13.84±2.76)天高于高于无呼吸机性相关性肺炎患者的(25.14±2.32)、11.11%、13.33%、(8.43±2.12)天(P<0.05),是引起呼吸机性相关性肺炎的危险因素.结论 呼吸机相关性肺炎发生率较高,与多种因素较多,通过预防预防误吸和反流、缩短呼吸机时间、减少镇静剂抑酸剂的应用、积极治疗基础病以减少呼吸机相关性肺炎发生.     

Repeated pulmonary aspiration in the aged demented patients

We investigated the aged demented inpatients who had repeated aspiration in our hospital during a period of 21 months from July 1997. Subjects are 60 patients aged from 65 to 94. We investigated the clinical background of the subjects, dividing them into the group with pneumonia and the group without pneumonia, and compared their type of dementia, grade of dementia, underlying diseases, laboratory data, diet, and outcome. We further compared the effect of mucoid diet for pneumonia. The most common underlying diseases were hypertension, cerebrovascular disease, diseases of the digestive system, and malignant tumor. There was no statistically significant difference in the outcome of the two groups. Within the subjects, death due to pneumonia was statistically significantly less in patients who had a mucoid diet. These findings suggested that a mucoid diet is useful for the protection against death caused by aspiration pneumonia.     

Cost of medication for influenza infected elderly inpatients]

Influenza vaccine is recommended for the elderly, a high-risk group for influenza infection. Unlike in many developed countries, the rate of influenza vaccination is extremely low in Japan. One of the primary reasons for this low level of vaccination use may be insufficient study on the cost-effectiveness of influenza vaccination in Japan. We determined the cost of medical tests and medications for inpatients with influenza in a referred hospital. We compared the medical costs by (1) level of daily life activity, (2) presence of pneumonia, and (3) living/dead status, 9 months after the infection. In addition, we set up a control group of patients for comparison of their medical costs to those of the influenza patients. Mean costs were 37,279 (+/- 26,784) yen for patients, and 2,361 (+/- 4,893) yen for controls. Mean costs were 32,424 (+/- 30,935) yen for inpatients without limitations to activity, 44,075 (+/- 20,937) yen for bed-bound inpatients, 44,614 (+/- 28,609) yen for inpatients with pneumonia, 27,009 (+/- 22,783) yen for inpatients without pneumonia, 57,624 (+/- 21,041) yen for inpatients who died within 9 months of the onset of influenza, and 16,934 (+/- 11,920) yen for inpatients who were alive 9 month after influenza infection.     

Pneumonie-Schwere-Index (PSI), CURB-65 und Mortalit?t bei hospitalisierten geriatrischen Patienten mit Aspirationspneumonie

Background

Aspiration pneumonia is associated with a high morbidity and mortality in elderly patients. In order to provide risk-adapted medical care, it is necessary to establish valid prognostic tools for these patients.

Objective

The value of two well-established scores to assess prognosis in community-acquired pneumonia (CAP), i.e., CURB-65 and the Pneumonia Severity Index (PSI), was evaluated in elderly patients hospitalized for aspiration pneumonia.

Material and methods

A total of 209 patients hospitalized with aspiration pneumonia between 2001 and 2005 in a single center were evaluated using PSI and CURB-65. For comparison of morbidity and mortality, an equally large group of inpatients with CAP was analyzed.

Results

The mean age of patients with aspiration pneumonia was 76.7±13.4 years, and 104 (49.8?%) were female. Patients with aspiration pneumonia more frequently showed a history of cancer, hypotension, and hyponatriemia on admission. Mortality was clearly higher in comparison to patients with CAP (39.2% vs. 16.3%). The Odds Ratio (OR) for mortality was 1.03 (95% CI 0.59; 1.79) for a CURB-65 score of 3?C5 points compared to 0?C2 points. In cases of CAP, OR showed a statistically significant increase of risk (OR 2.50; 95% CI 1.04; 6.06), for CURB-65 scores of 3?C5 points vs. 0?C2 points). In aspiration pneumonia, the PSI showed a trend towards increasing mortality within higher risk class.

Conclusions

In geriatric patients hospitalized with aspiration pneumonia, CURB-65 and PSI have no prognostic value.     

艾滋病合并重症卡氏肺孢子虫肺炎25例临床病例分析

目的探讨艾滋病(AIDS)合并重症肺孢子虫肺炎(PCP)的临床特点、诊断和治疗。方法分析重庆市公共卫生救治中心收治的25例AIDS合并重症PCP患者的临床资料。结果发热、咳嗽、进行性呼吸困难是最常见的临床症状,CD4+T淋巴细胞数为:2～68个/ul;典型影像表现是肺部磨玻璃影;25例重症PCP患者经过复方磺胺甲基异噁唑联合强的松治疗,如合并其他机会感染予以相应的治疗,14例好转,11例死亡,死亡患者大都同时合并其他病原菌感染。结论 AIDS合并重症PCP患者病情重,常合并多种病原菌及多系统感染,疗效欠佳,故采用合理有效的抗HIV治疗措施以减少其发病。     

老年急性脑血管病院内肺炎特点

目的探讨老年人急性脑血管病院内肺炎的特点。方法回顾性分析本院1996~2002年收治的2105例老年急性脑血管病患者院内肺炎的特点。结果2105例患者发生院内感染者248例,感染率为11.8%。其中肺炎162例,患病率为7.7%,占院内感染的65.3%,死亡37例,占院内感染死亡的80.4%,除常规给予抗生素治疗外,支持疗法、控制脑水肿,切断脑-肺之间的恶性循环,积极鼻饲减少误吸、雾化吸入局部抗炎是治疗此病的关键。结论老年急性脑血管病合并肺炎患病率较高。这与老年人的各器官趋向老化,生理功能逐年下降,内分泌、免疫功能低下等因素有关。     

急性脑卒中患者发生卒中相关性肺炎危险因素临床分析

目的探讨急性脑卒中患者发生卒中相关性肺炎(SAP)的危险因素,以降低SAP的发生率。方法收集2012年1月至2016年6月,在海南医学院第二附属医院神经内科就诊的380例急性脑卒中患者病例资料,根据是否发生卒中相关性肺炎(SAP)将其分为SAP组(69例)和非SAP组(311例),比较两组间差异,并分析SAP的相关危险因素。结果收集的380例急性脑卒中患者中,SAP的发生率为18.15%(69/380);单因素分析比较两组患者的临床特征,发现年龄≥65岁,意识障碍,吞咽困难,卧床,糖尿病,慢性支气管炎都是SAP发生的相关因素,差异有统计学意义(P0.05);OR值由高到低排序:意识障碍、吞咽困难、慢性支气管炎、糖尿病、年龄≥65岁、卧床;多因素非条件logistic回归分析,结果显示年龄≥65岁、意识障碍、吞咽困难、卧床、糖尿病、慢性支气管炎是急性脑卒中发生SAP的独立危险因素(P0.05)。结论 SAP的发生有很多相关危险因素,通过控制及改善急性脑卒中患者发生SAP的高危因素,采取积极正确的防治措施,可降低急性脑卒中患者患SAP的发生率,改善预后。     

Cerebrovascular disease and pneumonia in the elderly

Pneumonia is a common cause of death in elderly people. A series of our studies have demonstrated that pneumonia in the elderly is characterized by silent aspiration, impaired swallowing and cough reflex, partly due to cerebral infarctions at basal ganglia. These infarctions probably induce the disruption of the specific central neurotransmitter system including dopamine and substance P, which plays an important role for swallowing and cough reflex. Use of ACE inhibitor and stimulation of the oral cavity by simple oral care, which are effective in increasing substance P. reduced the incidence of aspiration pneumonia. Moreover, use of a dopamine agonist such as amantadine hydrochloride and a folic acid supplement that are known to potentiate dopaminergic neurons also prevented aspiration pneumonia. For patients bedridden due to lowered ADL, it is essential for them to keep an upright position a few hours after meals to prevent aspiration pneumonia caused by the reflux of ingested foods. Also, administration of neuroleptics may cause aspiration pneumonia by suppression of dopaminergic neurons.