CAJ | 학술논문

目的探讨老年人吸入性肺炎患者的临床表现及病理特征.方法回顾性分析卫生部北京医院1973-2002年经尸体解剖确诊的30例老年吸入性肺炎患者,其中男28例,女2例;年龄63 ～103岁,平均(83±9)岁.结果 30例均患有冠心病、脑血管病后遗症、高血压、慢性阻塞性肺疾病及2型糖尿病等多种基础疾病中的3种及以上疾病,17例长期接受鼻胃管进食,11例长期卧床.仅15例生前临床考虑为吸入性肺炎,并给予相应治疗.临床及X线胸片表现无特异性,痰培养显示以混合感染为主,多数病例有2种及以上病原菌感染,主要为绿脓杆菌、白色念珠菌、嗜麦芽窄食单胞菌及大肠埃希菌.尸体解剖结果显示30例中14例有多发性散在小脓肿形成,主要分布在细支气管及周围肺组织,以多叶分布为主.单侧或双侧胸腔积液20例.30例病理检查均可见到异物巨细胞.影像学表现与病理所见一致性较差,13例肺部病变影像学表现与病理所见相符,15例影像学诊断是否合并胸腔积液与尸体解剖结果相符.结论老年吸入性肺炎患者合并多种基础疾病及误吸相关危险因素,且多为混合感染,病理常见多发性小脓肿形成,确诊困难,肺外表现多见.老年人隐性误吸的吸入量小,易反复发生.误吸相关危险因素的评估对老年吸入性肺炎的临床诊断起重要作用.
목적 탐토노년인흡입성폐염환자적림상표현급병리특정.방법 회고성분석위생부북경의원1973-2002년경시체해부학진적30례노년흡입성폐염환자,기중남28례,녀2례;년령63 ～103세,평균(83±9)세.결과 30례균환유관심병、뇌혈관병후유증、고혈압、만성조새성폐질병급2형당뇨병등다충기출질병중적3충급이상질병,17례장기접수비위관진식,11례장기와상.부15례생전림상고필위흡입성폐염,병급여상응치료.림상급X선흉편표현무특이성,담배양현시이혼합감염위주,다수병례유2충급이상병원균감염,주요위록농간균、백색념주균、기맥아착식단포균급대장애희균.시체해부결과현시30례중14례유다발성산재소농종형성,주요분포재세지기관급주위폐조직,이다협분포위주.단측혹쌍측흉강적액20례.30례병리검사균가견도이물거세포.영상학표현여병리소견일치성교차,13례폐부병변영상학표현여병리소견상부,15례영상학진단시부합병흉강적액여시체해부결과상부.결론 노년흡입성폐염환자합병다충기출질병급오흡상관위험인소,차다위혼합감염,병리상견다발성소농종형성,학진곤난,폐외표현다견.노년인은성오흡적흡입량소,역반복발생.오흡상관위험인소적평고대노년흡입성폐염적림상진단기중요작용.
Objective To explore the clinicopathological characteristics of aspiration pneumonia in the elderly.Methods The clinical data of 30 cases of autopsy-proven aspiration pneumonia in Beijing Hospital from 1973 to 2002 were reviewed.The patients consisted of 28 males and 2 females,aged from 63 to 103 [mean(83 ± 9)] years.Results Only 15 cases were clinically diagnosed as aspiration pneumonia before death.Concomitant diseases were severe and complex,mostly coronary disease,cerebrovascular disease,hypertension,COPD,and diabetes mellitus.All the patients suffered from at least 3 concomitant diseases.Long-term bedridden and nasogastric feeding was seen in 11 and 17 patients respectively.The clinical presentation and chest X-ray of aspiration pneumonia in the elderly were nonspecific and variable.Mixed infections were common.The main bacteria isolated were Gram-negative bacilli,in particular Pseudomonas aeruginosa,Stenotrophomonas maltophilia,Escherichia coli and Candida albicans.By pathology,macrophages with foreign bodies were found in all the 30 cases and multiple small abscesses were found in 14 cases.The lesions were adjacent to the bronchioles and in the lung tissue around the bronchioles,mostly multi-lobar and bilateral.Unilateral or bilateral pleural effusion developed in 20 patients.The accordance between radiological and pathological diagnosis of aspiration pneumonia was very poor.The foci of infection detected by X-ray were proven by autopsy in 13 patients,while pleural effusions in X-ray were proven by autopsy in 15 patients.Conclusions Multi-concomitant diseases,mixed infection and extra-pulmonary presentations were common in elderly patients with aspiration pneumonia.Multiple small abscesses were the pathological characteristics of aspiration pneumonia in the aged.A definite clinical diagnosis of aspiration pneumonia was difficult.Recurrent silent microaspiration was a feature of aspiration in the elderly.The assessment of risk factor of aspiration played an important role in the clinical diagnosis of aspiration pneumonia.