iration and iration pneumonia吸入和吸入性肺炎.pdfVIP

Medical Care for the Elderly Aspiration and Aspiration Pneumonia JMAJ 46(1): 12–18, 2003 Tsuyoshi NAGATAKE Professor, Department of Internal Medicine, Institute of Tropical Medicine, Nagasaki University Abstract: It is not rare for aspiration to occur in association with a severe parox- ysm of coughing in elderly people. In such cases, a depressed cough reflex may result in severe aspiration pneumonia. Aspiration becomes clinically evident when the patient chokes or has a fit of coughing during a meal. In contrast, a less obvious form of aspiration, which is almost asymptomatic, is called micro-aspiration. When food or drink, saliva containing oral microbial flora, or regurgitated gastric acid is aspirated into the airway, severe inflammation of the lower respiratory tract and lung parenchyma occurs. Since aspiration can cause pneumonia and serious airway damage, the prevention of aspiration is important, particularly in elderly people. Pathogenic microorganisms are more likely to colonize the oral cavity in patients with swallowing disorders. Thus, when patients with swallowing disorders are admitted to a hospital, they are at a higher risk of encountering nosocomial pathogens, i.e., multidrug-resistant bacteria. Therefore, protection against aspi- ration and prevention of lower respiratory tract infection by ensuring good oral hygiene may be the most practical and effective means for the prevention of pneumonia in the elderly. Key words: Aspiration pneumonia; Hospital-acquired pneumonia; Depressed cough reflex; Anaerobic infections Introduction Aspiration b