Yamamoto K, Yamada Y, Hayashi Y, Takeuchi T, Adachi S, Suzuki K, Yamamoto T
First Department of Internal Medicine, Nagoya City University, Medical School.
Kansenshogaku Zasshi. 1990 Dec;64(12):1493-8. doi: 10.11150/kansenshogakuzasshi1970.64.1493.
We compared hospital acquired pneumonia (HAP) with nursing home acquired pneumonia in the elderly. There were no differences in the underlying diseases, clinical signs and symptoms between HAP and nursing home acquired pneumonia, but activities of daily living were poor in HAP than nursing home acquired pneumonia. By the bacterial studies from Transtracheal aspiration (TTA), S. aureus, K. pneumoniae, P. aeruginosa and anaerobes were more isolated in HAP. On the other hand, S. pneumoniae and H. influenzae were isolated more in the nursing home acquired pneumonia. In the laboratory data, no difference was detected in inflammatory reaction between both groups, but in immunological data, especially complement C3 and tuberculin skin test were markedly reduced in HAP. The prognosis were significantly poor in HAP because the fatal rate was higher in HAP than nursing home acquired pneumonia. With regard to HAP in the elderly, severe underlying disease, poor whole body state, aspiration, bacterial resistance to drugs, superinfection and polymicrobial infection were the factors predisposing difficulty in treatment of pneumonia in the elderly. From the above results, prevention is the most necessary in HAP.
我们比较了老年人医院获得性肺炎（HAP）和养老院获得性肺炎。HAP与养老院获得性肺炎在基础疾病、临床体征和症状方面没有差异，但HAP患者的日常生活活动能力比养老院获得性肺炎患者差。通过经气管抽吸（TTA）进行细菌学研究发现，HAP中金黄色葡萄球菌、肺炎克雷伯菌、铜绿假单胞菌和厌氧菌的分离率更高。另一方面，养老院获得性肺炎中肺炎链球菌和流感嗜血杆菌的分离率更高。在实验室数据方面，两组间炎症反应未检测到差异，但在免疫学数据中，尤其是补体C3和结核菌素皮肤试验在HAP中显著降低。HAP的预后明显较差，因为HAP的死亡率高于养老院获得性肺炎。对于老年人的HAP，严重的基础疾病、全身状态差、误吸、细菌耐药、二重感染和多微生物感染是导致老年人肺炎治疗困难的因素。从上述结果来看，预防HAP最为必要。
