老年肺炎发病危险因素研究进展.docVIP

老年肺炎发病危险因素研究进展 　　[摘要] 肺炎是老年人最常见的感染性疾病之一，严重影响老年人的生活质量和寿命，是老年COPD及肺癌死亡的主要诱因，是住院患者的主要并发症，而且病死率高。老年人基础疾病多，抵抗力差，肺炎的表现也不典型，可能没有明显的咳嗽、咳痰，甚至开始表现为消化、神经症状；脏器老化，对抗生素耐药，治疗时需特别注意监测肝肾功能。老年肺炎危害性大、治疗复杂。本文旨在对老年肺炎发病的危险因素进行综述，让大家更好地预防老年肺炎。 　　[关键词] 肺炎；老年人；危险因素；研究 　　[中图分类号] R563.1 [文献标识码] A [文章编号] 1674-4721（2011）11（c）-０13－０3 　　 　　Research progress of the risk factors of senile pneumonia 　　XIE Zizheng, LIU Hua* 　　Cadre Health Care Department, the First Hospital Affiliated to Guangdong Pharmaceutical University, Guangdong Province, Guangzhou 510080, China 　　[Abstract] Pneumonia is one of the most common infectious diseases in the elderly, it can affect the older peoples quality of life and life expectancy seriously. Pneumonia is the main inducement factors of elderly COPD and lung cancer, and it is the main complication of inpatients, the mortality rate is quite high. The elderly have many underlying diseases and poor immunity, the performance of pneumonia is not typical, they may not be obvious cough, sputum, and even begin as a digestive, neurological symptom; organ of elderly people is aged, resistance to antibiotics, we should pay particular attention to monitor liver and kidney function. Senile pneumonia can cause great harm to elderly and the treatment is complicated.This article aims to review the risk factors of senile pneumonia, so that we can better prevent senile pneumonia. 　　[Key words] Pneumonia; Elder; Risk factors; Research 　　 　　WHO的统计资料表明急性呼吸道感染在全球人口死因中排序第2位，肺炎病死率占呼吸道急性感染病死率75.5%。全美每年有200～400 万社区获得性肺炎（CAP）患者。65 岁以上人群的CAP的发病率为55.6%[1]。我国在各种死亡病因中，肺炎占第5位。西班牙的一项大规模的流行病调查发现老年社区肺炎的发病率是3.48‰[2]。上海住院患者的医院内肺炎发病率是4.81%[3]。Fine等研究发现年龄大于65岁本身可能不是引起老年肺炎发病率和死亡率增高的最重要危险因子，但有可能使老年人易处于基础危险状态[4]。老龄、气管插管、慢性疾病、营养不良、接受免疫抑制剂治疗等都是老年人易患肺炎的高危易感因素。 　　1 口腔内正常菌群变貌及吞咽咳嗽反应降低导致阻止病原体侵入的能力降低 　　正常情况下，口腔内栖有非病原性菌群，主要为口腔链球菌、韦荣球菌类和消化球菌类细菌。牙隙隐蔽处又有放线菌类和少量肺炎球菌、溶血性链球菌和流感嗜血杆菌等病原性细菌，但在正常菌群影响下不易增殖。老年人多不关心口腔卫生，或由于应用抗生素、营养缺乏及齿龈炎等，口腔中易检出革兰阴性杆菌。或又有胃、食管反流而污染口腔时，可导致口腔菌群改变[5]。研究发现严格的口腔卫生管理能够减少住院患者和老人的肺炎发生率[6]。