Analysis on Clinical Characteristics of Community-acquired Pneumonia in Elderly Patients_West China Medical Journal

Authors：

WANG Wei , LI Hongyan , SUN Haiqing , HU Yongxia , YAO Junxiu

Cadre ward, Chengdu Military General Hospital, Chengdu, Sichuan 610083, P. R. China;

Corresponding author：

Keywords：

老年; 社区获得性肺炎; 病原学; 临床特征; 抗生素; 预后

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目的　探讨老年社区获得性肺炎的临床特征、病原学特点及抗生素的合理选择。方法　选择2010年1月1日－12月31日呼吸内科和干部病房住院治疗并确诊为社区获得性肺炎，年龄≥60岁的126例患者，从病原学、临床表现、辅助检查结果及治疗转归方面入手，回顾性分析老年社区获得性肺炎的临床特征。结果　77.7%（98/126）的老年社区获得性肺炎患者合并有其他基础疾病，其中84.7%（83/98）合并慢性阻塞性肺病，81.6%（80/98）合并高血压，39.2%（40/98）合并冠心病，25.5%（25/98）合并有糖尿病。126例患者中，68.3%（86/126）有气促等呼吸道症状，75.6%（95/126）有食欲减退等消化道症状，61.1%（77/126）有反应迟钝等精神状态的改变；72.2%（91/126）的患者肺部体征明显，而27.8%（35/126）的患者无明显肺部体征；88.9%（112/126）的老年患者胸部CT提示有斑点状、小片状阴影。有89例患者进行了痰培养，其中58例出现阳性结果，46例对头孢菌素敏感、36例对喹诺酮类药物敏感、39例对氨基糖甙类敏感及青霉素敏感。给予抗感染、支持对症治疗后，56.3%（71/126）的患者治愈、33.3%（42/126）的患者病情好转、10.3%（13/126）的患者死亡，死亡原因均为呼吸衰竭。结论　老年社区获得性肺炎患者临床特征复杂，应重视其社区获得性肺炎的早期诊断，并进行及时有效的治疗。

Citation： WANG Wei,LI Hongyan,SUN Haiqing,HU Yongxia,YAO Junxiu. Analysis on Clinical Characteristics of Community-acquired Pneumonia in Elderly Patients. West China Medical Journal, 2012, 27(6): 863-865. doi: Copy

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13.	何礼贤. 成人社区获得性肺炎的诊治及其规范化管理[J]. 中国感染与化疗杂志, 2011, 11(4): 317-320.
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1. 　Gutiérrez F, Masiá M. Improving outcomes of elderly patients with community-acquired pneumonia[J]. Drugs Aging, 2008, 25(7): 585-610.
2. 　Marrie TJ. Community-acquired pneumonia in the elderly[J]. Clin Infect Dis, 2000, 31(4): 1066-1078.
3. 　Schmidt-Ioanas M, Lode H. Treatment of pneumonia in elderly patients[J]. Expert Opin Pharmacother, 2006, 7(5): 499-507.
4. 　中华医学会呼吸病学分会. 社区获得性肺炎诊断和治疗指南[J]. 中华结核和呼吸杂志, 2006, 29(10): 651-655.
5. 　Fung HB, Monteagudo-Chu MO. Community-acquired pneumonia in the elderly [J]. Am J Geriatr Pharmacother, 2010, 8(1): 47-62.
6. 　El-Solh AA, Pietrantoni C, Bhat A, et al. Microbiology of severe aspiration pneumonia in institutionalized elderly[J]. Am J Respir Crit Care Med, 2003, 167(12): 1650-1654.
7. 　van Duin D. Diagnostic challenges and opportunities in older adults with infectious diseases [J]. Clin Infect Dis, 2012, 54(7): 973-978.
8. 　Frei CR, Attridge RT, Mortensen EM, et al. Guideline-concordant antibiotic use and survival among patients with community-acquired pneumonia admitted to the intensive care unit[J]. Clin Ther, 2010, 32(2): 293-299.
9. 　File TM. The science of selecting antimicrobials for community-acquired pneumonia (CAP) [J]. J Manag Care Pharm, 2009, 15(2 Suppl): S5-S11.
10. 　Watkins RR, Lemonovich TL. Diagnosis and management of community-acquired pneumonia in adults[J]. Am Fam Physician, 2011, 83(11): 1299-1306.
11. 　Arnold FW, Lajoie AS, Brock GN, et al. Improving outcomes in elderly patients with community-acquired pneumonia by adhering to national guidelines: Community-Acquired Pneumonia Organization International cohort study results[J]. Arch Intern Med, 2009, 169(16): 1515-1524.
12. 　李群, 李为民, 高属生, 等. 四川地区社区获得性肺炎的病原学调查[J]. 华西医学, 2008, 23(2): 275-277.
13. 　何礼贤. 成人社区获得性肺炎的诊治及其规范化管理[J]. 中国感染与化疗杂志, 2011, 11(4): 317-320.
14. 　McCabe C, Kirchner C, Zhang H, et al. Guideline-concordant therapy and reduced mortality and length of stay in adults with community-acquired pneumonia: playing by the rules[J]. Arch Intern Med, 2009, 169(16): 1525-1531.

West China Medical Journal

Analysis on Clinical Characteristics of Community-acquired Pneumonia in Elderly Patients

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