Delerme Samuel, Ray Patrick
Emergency Department, CHU Pitié-Salpétriêre, 47-83 boulevard de l'hopital, 75013 Paris, Université Pierre et Marie Curie-Paris 6, France.
Age Ageing. 2008 May;37(3):251-7. doi: 10.1093/ageing/afn060. Epub 2008 Apr 3.
Acute respiratory failure (ARF) in patients over 65 years is common in emergency departments (EDs) and is one of the key symptoms of congestive heart failure (CHF) and respiratory disorders. Searches were conducted in MEDLINE for published studies in the English language between January 1980 and August 2007, using 'acute dyspnea', 'acute respiratory failure (ARF)', 'heart failure', 'pneumonia', 'pulmonary embolism (PE)' keywords and selecting articles concerning patients aged 65 or over. The age-related structural changes of the respiratory system, their consequences in clinical assessment and the pathophysiology of ARF are reviewed. CHF is the most common cause of ARF in the elderly. Inappropriate diagnosis that is frequent and inappropriate treatments in ED are associated with adverse outcomes. B-type natriuretic peptides (BNPs) help to determine an accurate diagnosis of CHF. We should consider non-invasive ventilation (NIV) in elderly patients hospitalised with CHF or acidotic chronic obstructive pulmonary disease (COPD) who do not improve with medical treatment. Further studies on ARF in elderly patients are warranted.
65岁以上患者的急性呼吸衰竭（ARF）在急诊科很常见，是充血性心力衰竭（CHF）和呼吸系统疾病的关键症状之一。检索MEDLINE数据库，查找1980年1月至2007年8月间发表的英文研究，使用“急性呼吸困难”、“急性呼吸衰竭（ARF）”、“心力衰竭”、“肺炎”、“肺栓塞（PE）”等关键词，并选择有关65岁及以上患者的文章。本文综述了呼吸系统与年龄相关的结构变化、其在临床评估中的后果以及ARF的病理生理学。CHF是老年人ARF最常见的病因。急诊科常见的诊断不当和治疗不当与不良后果相关。B型利钠肽（BNP）有助于准确诊断CHF。对于因CHF或酸中毒慢性阻塞性肺疾病（COPD）住院且药物治疗效果不佳的老年患者，应考虑无创通气（NIV）。有必要对老年患者的ARF进行进一步研究。
