CAJ | 학술논문

目的分析75岁以上老年人原发性帕金森病(OEIPD)患者的临床特点和死亡原因,为改善OEIPD 的治疗和预防提供资料.方法对15例OEIPD 患者进行前瞻性长期临床观察,并结合尸检资料分析死亡原因.结果 15例平均病程为6.2±3.6年,临床类型以少动及少动伴震颤占多数(80.0%).12例在病程后期(发病后4.8±3.5年)出现呛咳,呛咳症状出现后平均4个月开始鼻饲.最常见的并发症为反复呼吸道感染,平均2.9±1.9次.死亡原因中支气管肺炎和感染性休克11例(73.3%),急性心肌梗死2例,心肌梗死伴心脏破裂及主动脉瘤破裂各1例.结论①OEIPD患者病程短,应及时应用复方左旋多巴治疗;②死亡原因多为肺炎和感染性休克,呛咳是肺炎主要原因之一.因此,出现呛咳时应尽早鼻饲,也应训练患者用声门上吞咽法.
목적분석75세이상노년인원발성파금삼병(OEIPD)환자적림상특점화사망원인,위개선OEIPD 적치료화예방제공자료.방법대15례OEIPD 환자진행전첨성장기림상관찰,병결합시검자료분석사망원인.결과 15례평균병정위6.2±3.6년,림상류형이소동급소동반진전점다수(80.0%).12례재병정후기(발병후4.8±3.5년)출현창해,창해증상출현후평균4개월개시비사.최상견적병발증위반복호흡도감염,평균2.9±1.9차.사망원인중지기관폐염화감염성휴극11례(73.3%),급성심기경사2례,심기경사반심장파렬급주동맥류파렬각1례.결론①OEIPD환자병정단,응급시응용복방좌선다파치료;②사망원인다위폐염화감염성휴극,창해시폐염주요원인지일.인차,출현창해시응진조비사,야응훈련환자용성문상탄인법.
Objective To improve the therapeutic and preventive measure for elderly patients (75 years and over) with idiopathic Parkinson's disease (OEIPD).Methods Fifteen OEIPD patients were observed prospectively over a long period of time. Their diagnosis was confirmed by autopsy. Based on clinical and pathological data, the causes of death were analyzed.Results The mean clinical course in OEIPD patients was 6.2±3.6 years. The majority of the 15 patients were the akinetic type and the akinetic type with tremor (80.0%). In the late stages of disease (4.8±3.5 year), choking occurred in 12 OEIPD patients who received nasal feeding for an average of 4 months after the occurrence of choking. The most common complication in 12 patients was repeated pulmonary infections with an average rate of 2.9±1.9. The causes of death were bronchial pneumonia and shock induced by pulmonary infection (11 cases, accounted for 73.3%), acute myocardial infarction (2 cases), one case with cardiac rupture and one case with rupture of aortic aneurysm.Conclusions The clinical course was shorter in OEIPD patients. Levodopa therapy should be started early in OEIPD patients. Bronchial pneumonia and infectious shock constitute the major cause of death and choking was one of the main causes of aspiration pneumonia. Nasal feeding should be started as early as possible after the appearance of choking. Silent aspiration can be reduced by teaching the patient to protect the airway by 'supraglottic swallowing'.