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目的了解高龄铜绿假单胞菌肺炎(Pseudomouas aeruginosa pneumonia,PAP)高危因素,分析其在病人中的分布情况,为防治高龄PAP提供线索。方法对某院老年呼吸内科2003年7月～2009年6月收治的98例80岁以上高龄PAP患者的临床资料进行回顾性分析。结果 98例80岁以上高龄PAP高危因素主要有基础疾病与危险因素二要素。按PAP的发生率,基础疾病主要有神经系统疾病(43.8%),其中脑梗塞(14.3%)、脑出血(9.2%)后遗症、老年痴呆症(12.2%)、帕金森氏病6.1%;其次为营养不良与代谢性疾病患者,35.7%低蛋白血症患者发生PAP,贫血与糖尿病的PAP分别是37.7%和36.7%;再次是肺部恶性肿瘤患者(33.7%);第四是肺部结构受损性疾病,主要是COPD、支气管扩张症和肺纤维化,其PAP发病率分别是27.2%、12.2%和8.2%;此外,部分器官(心、肾)功能不全患者尤其慢性充血性心功能不全者也有较高的PAP发病率(25.5%)。危险因素主要有既往铜绿假单胞菌感染或定植史(38.8%)、1年内住院次数(37.7%)、机械通气(35.8%)、气管插管或气管切开(33.6%)、反复呕吐误吸(32.6%)、本次住院天数(28.5%)、3月内使用抗菌素(28.5%)、3月内糖皮质激素使用史及留置尿管、深静脉管和胃管。结论多种基础疾病与危险因素是PAP高危因素,在基础疾病上复加危险因素,PAP发生率可能更高。积极治疗原发疾患同时,减少和控制危险因素,有助于预防或减少高龄PAP发生。
Objective To investigate the risk factors of Pseudomonas aeruginosa pneumonia (Pseudomonas aeruginosa pneumonia) in elderly patients and to analyze its distribution in patients, providing clues for the prevention and treatment of elderly PAP. Methods A retrospective analysis was performed on the clinical data of 98 elderly PAP patients over 80 years of age from July 2003 to June 2009 in the department of Geriatric Respiratory Medicine in a hospital. Results 98 cases of elderly over 80 years of age PAP risk factors mainly include two elements of underlying diseases and risk factors. According to the incidence of PAP, the main underlying diseases were neurological diseases (43.8%), including cerebral infarction (14.3%), sequelae of cerebral hemorrhage (9.2%), Alzheimer’s disease (12.2%) and Parkinson’s disease In patients with malnutrition and metabolic diseases, PAP was found in 35.7% of hypoproteinemic patients and PAP was 37.7% and 36.7% in anemia and diabetes mellitus respectively; again in patients with pulmonary malignancies (33.7%); and fourthly in lung structure Damaged diseases, mainly COPD, bronchiectasis and pulmonary fibrosis, the incidence of PAP were 27.2%, 12.2% and 8.2%; In addition, some organs (heart, kidney) patients with especially congestive heart failure Incomplete people also have a higher incidence of PAP (25.5%). The major risk factors were previous Pseudomonas aeruginosa infection or colonization (38.8%), hospitalization within one year (37.7%), mechanical ventilation (35.8%), intubation or tracheotomy (33.6%), recurrent vomiting (32.6%), hospital stay (28.5%), use of antibiotics in March (28.5%), history of glucocorticoid use in March and indwelling catheter, deep vein and gastric tube. Conclusions A variety of underlying diseases and risk factors are the risk factors of PAP. Associated with risk factors in the underlying diseases, the incidence of PAP may be higher. Active treatment of the primary disease at the same time, reduce and control risk factors, help prevent or reduce the occurrence of elderly PAP.