Mylotte Joseph M, Goodnough Susan, Naughton Bruce J
Department of Medicine, Division of Infectious Diseases, School of Medicine and Biomedical Sciences, State University of New York, Buffalo, USA.
J Am Geriatr Soc. 2003 Jan;51(1):17-23. doi: 10.1034/j.1601-5215.2002.51004.x.
To determine the frequency of aspiration pneumonitis in nursing home residents with an initial diagnosis of pneumonia and to compare the clinical characteristics, management, and outcome of aspiration pneumonitis with those of pneumonia.
Retrospective chart review.
Hospital geriatric unit for nursing home residents.
Nursing home residents admitted to the inpatient geriatric unit with suspected pneumonia between May 1999 and April 2001 (n = 195 episodes).
Aspiration events were defined as definite (witnessed or unwitnessed) or suspected. Aspiration pneumonitis was defined as symptoms/signs of lower respiratory tract infection plus a history of an aspiration event plus a lower lobe infiltrate on chest radiograph. Pneumonia was defined as symptoms/signs of lower respiratory tract infection plus an infiltrate on chest radiograph plus no history of an aspiration event.
The 195 episodes were stratified into three clinical groups: aspiration pneumonitis (n = 86; aspiration history/infiltrate), pneumonia (n = 43; no aspiration history/infiltrate), and an aspiration event (n = 66; aspiration history/no infiltrate). In general, symptoms, signs, and laboratory tests were not useful in distinguishing between the three groups. Survivors with aspiration pneumonitis (13/75 (17%)) or with an aspiration event (20/60 (33%)) were significantly more likely not to be treated with an antibiotic or to be treated for 1 day or less than those with pneumonia (0/41; P <.001). Excluding those not treated, significantly more patients with pneumonia (33/40 (83%)) were discharged on antibiotic treatment than those with aspiration pneumonitis (35/70 (50%)) or an aspiration event (21/51 (41%); P <.001). There was no significant difference in hospital mortality between the three clinical groups.
The findings of this study have implications for the diagnosis and management of suspected pneumonia in nursing home residents but require prospective validation.
确定初步诊断为肺炎的养老院居民中吸入性肺炎的发生率，并比较吸入性肺炎与肺炎的临床特征、治疗及预后。
回顾性病历审查。
收治养老院居民的医院老年科。
1999年5月至2001年4月间因疑似肺炎入住老年科病房的养老院居民（共195例）。
吸入事件定义为明确的（有目睹或无目睹）或疑似的。吸入性肺炎定义为下呼吸道感染的症状/体征加上吸入事件史加上胸部X线片显示下叶浸润。肺炎定义为下呼吸道感染的症状/体征加上胸部X线片显示浸润且无吸入事件史。
195例被分为三个临床组：吸入性肺炎（n = 86；有吸入史/有浸润）、肺炎（n = 43；无吸入史/有浸润）和吸入事件（n = 66；有吸入史/无浸润）。总体而言，症状、体征和实验室检查对区分这三组并无帮助。吸入性肺炎幸存者（13/75（17%））或有吸入事件者（20/60（33%））未接受抗生素治疗或治疗1天及以内的可能性显著高于肺炎患者（0/41；P <.001）。排除未接受治疗者，接受抗生素治疗出院的肺炎患者（33/40（83%））显著多于吸入性肺炎患者（35/70（50%））或有吸入事件者（21/51（41%）；P <.001）。三组临床组的医院死亡率无显著差异。
本研究结果对养老院居民疑似肺炎的诊断和治疗具有指导意义，但需要前瞻性验证。
