Teramoto Shinji, Yoshida Kazufumi, Hizawa Nobuyuki
Department of Pulmonary Medicine, Hitachinaka Medical Education and Research Center, University of Tsukuba, 20-1 Hitachinaka-shi, Ibaraki 329-8575, Japan.
Department of Pulmonary Medicine, Hitachinaka General Hospital, Hitachi Ltd., Ibaraki, Japan.
Respir Investig. 2015 Sep;53(5):178-84. doi: 10.1016/j.resinv.2015.01.003. Epub 2015 Mar 20.
Pneumonia in the elderly results in the highest mortality among cases of community-acquired pneumonia (CAP). The pathophysiology of pneumonia in the elderly is primarily due to aspiration pneumonia (ASP). ASP comprises two pathological conditions: airspace infiltration with bacterial pathogens and dysphagia-associated miss-swallowing. The first-line therapy for the treatment of bacterial pneumonia in the elderly is a narrow spectrum of antibiotics, including sulbactam/ampicillin, which are effective against major lower respiratory infection pathogens and anaerobes. The bacterial pathogens of ASP cases of pneumonia in the elderly are similar to those associated with adult CAP. In addition to an appropriate course of antibiotics, pharmacologic and non-pharmacologic approaches for dysphagia and upper airway management are necessary for the treatment and prevention of pneumonia. Swallowing rehabilitation, oral health care, pneumococcal vaccination, gastroesophageal reflux management, and a head-up position during the night are necessary for the treatment and prevention of repeated episodes of pneumonia in elderly patients. In addition, tuberculosis should always be considered for the differential diagnosis of pneumonia in this patient population.
老年肺炎在社区获得性肺炎（CAP）病例中导致的死亡率最高。老年人肺炎的病理生理学主要归因于吸入性肺炎（ASP）。ASP包括两种病理状况：细菌性病原体导致的肺泡腔浸润和吞咽困难相关的误吸。老年细菌性肺炎的一线治疗药物是窄谱抗生素，包括舒巴坦/氨苄西林，它们对主要的下呼吸道感染病原体和厌氧菌有效。老年ASP肺炎病例的细菌病原体与成人CAP相关的病原体相似。除了适当疗程的抗生素外，针对吞咽困难和上呼吸道管理的药物和非药物方法对于肺炎的治疗和预防是必要的。吞咽康复、口腔卫生保健、肺炎球菌疫苗接种、胃食管反流管理以及夜间抬高床头对于老年患者肺炎复发的治疗和预防是必要的。此外，对于该患者群体的肺炎鉴别诊断应始终考虑结核病。
