Manabe Toshie, Kotani Kazuhiko, Teraura Hiroyuki, Minami Kensuke, Kohro Takahide, Matsumura Masami
Division of Community and Family Medicine, Center of Community Medicine, Jichi Medical University, Shimotsuke-City, Tochigi 329-0498, Japan.
Division of Infectious Diseases, Jichi Medical University Hospital, Shimotsuke-City, Tochigi 329-0498, Japan.
Geriatrics (Basel). 2020 Jul 7;5(3):42. doi: 10.3390/geriatrics5030042.
Aspiration pneumonia (AsP), a phenotype of community-acquired pneumonia (CAP), is a common and problematic disease with symptomless recurrence and fatality in old adults. Characteristic factors for distinguishing AsP from CAP need to be determined to manage AsP. No such factorial markers in oldest-old adults, who are often seen in the primary-care settings, have yet been established. From the database of our Primary Care and General Practice Study, including the general backgrounds, clinical conditions and laboratory findings collected by primary care physicians and general practitioners, the records of 130 patients diagnosed with either AsP (n = 72) or CAP (n = 58) were extracted. Characteristic factors associated with the diagnosis of AsP were statistically compared between AsP and CAP. The patients were older in the AsP group (median 90 years old) than in the CAP group (86 years old). The body temperature, heart rate, and diastolic blood pressure were lower in the patients with AsP than in those with CAP. Witnessed meal dysphagia by families and caregivers was reported only in AsP. Living in a nursing home, comorbidities of cerebral infarction and dementia (as positive factors) and hypertension (as a negative factor) were considered predictive to diagnose AsP in a stepwise logistic regression analysis. Among oldest-old adults in primary-care settings, living in a nursing home and the dysphagia risks are suggested to be characteristic factors for diagnosing AsP. Age and some relevant clinical information may help manage AsP and also be useful for families and caregivers.
吸入性肺炎（AsP）是社区获得性肺炎（CAP）的一种表型，是一种常见且棘手的疾病，在老年人中有无症状复发和致死情况。需要确定区分AsP与CAP的特征性因素以管理AsP。在基层医疗环境中常见的高龄老年人中，尚未建立这样的因素标志物。从我们的基层医疗和全科医学研究数据库中，提取了130例被诊断为AsP（n = 72）或CAP（n = 58）患者的记录，该数据库包括基层医疗医生和全科医生收集的一般背景、临床状况和实验室检查结果。对AsP组和CAP组之间与AsP诊断相关的特征性因素进行了统计学比较。AsP组患者（中位年龄90岁）比CAP组患者（86岁）年龄更大。AsP患者的体温、心率和舒张压低于CAP患者。仅在AsP患者中报告有家人和护理人员目睹的进餐吞咽困难。在逐步逻辑回归分析中，居住在养老院、合并脑梗死和痴呆（作为阳性因素）以及高血压（作为阴性因素）被认为是诊断AsP的预测因素。在基层医疗环境中的高龄老年人中，居住在养老院和吞咽困难风险被认为是诊断AsP的特征性因素。年龄和一些相关临床信息可能有助于管理AsP，对家人和护理人员也有用。
